Pulmonary Oedema Flashcards
What are the 4 main causes of pulmonary oedema?
Increased Left Atrial pressure
Increased pre load
Decreased oncotic pressure
Increased pulmonary vessel permeability
What causes increased preload of blood flowing to the pulmonary circulation?
Iatrogenic giving too much fluids to a patient
When the body is in stress what hormone is released leading to water retention to try and increase the blood pressure?
ADH
What causes oncotic pressure to reduce leading to pulmonary oedema?
Decreased levels of albumin
What causes increased permeability to the pulmonary vessels leading to pulmonary oedema?
Release of cytokines from Inflammatory processes like infections (pneumonia)
What causes increased permeability to the pulmonary vessels leading to pulmonary oedema?
Release of cytokines from Inflammatory processes like infections (pneumonia)
What are the categories that the 10 causes of increased left atrial pressure that cause pulmonary oedema can be put in?
Left ventricular failures
Arryhthmias
Valvular disease
Restrictive cardiomyopathies
HTN
Endocrine issues
What is the most common cause of pulmonary oedema due to increased left atrial pressure?
Left Ventricular Diastolic Failure (LVDF)
What are the 2 types of left ventricular failure that can cause increased Left Atrial pressure leading to pulmonary oedema?
Left Ventricular Diastolic Failure (HFpEF)
Left Ventricular Systolic Failure (HFrEF)
What is the pathophysiology of left ventricular diastolic dysfunction (HFpEF)?
Ventricle has become stiff/non compliant so its filling in diastole is impaired
What arrhythmia causes increased Left Atrial pressure leading to pulmonary oedema?
Atrial fibrillation (AF)
What are the 3 reasons that atrial fibrillation (AF) causes increased left atrial pressure leading to pulmonary oedema?
Reduced diastolic emptying due to less time in diastole with the HR being faster
Loss of atrial systole
Irregular blood flow
What are the 3 causes of Left Ventricular Systolic Failure (HFrEF) leading to increased left atrial pressure causing pulmonary oedema?
Myocardial infarction
Myocardial ischaemia
Myocarditis
What are the valvular diseases that can cause increased left atrial pressure leading to pulmonary oedema?
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
What are some causes of mitral regurgitation that can increase left atrial pressure leading to pulmonary oedema?
Infective endocarditis
Rheumatic heart disease
Myocardial infarction
Acute chordae tendineae rupture
What are the 2 ways a Myocardial infarction cause mitral regurgitation which can increase left atrial pressure leading to pulmonary oedema?
Anterior infarction (LAD) damages papillary muscles which hold thee ANTERIOR leaflet preventing it from being pushed too far open
Circumflex infarction means posterior leaflet stays open
Why can a pregnant woman not be allowed tot give birth if she has severe mitral stenosis?
As soon as given birth, clamping down on the placenta leads to all of its fluid returning back into circulation rapidly causing rapid increase in Left atrial pressure leading to arrhythmia, acute pulmonary oedema and cardiac arrest
What can cause a dynamic mitral stenosis?
Atrial Myxoma
What can cause mitral stenosis?
Rheumatic fever
Age related calcification
Infective endocarditis
Rheumatoid or SLE
What can cause aortic regurgitation that leads to increase left atrial pressure leading to pulmonary oedema?
Type A aortic dissection
Infective endocarditis
What is a type A aortic dissection?
Any part of the ascending aorta is ruptured or the aortic arch is ruptured
How does hypertension lead to increase left atrial pressure leading to pulmonary oedema?
Increased pre load in the left ventricle leads to ventricular stiffness and remodellingi
How do patients present with Malignant Hypertension/ how is it diagnosed?
SBP > 180 DBP > 120
Present with at least 1 of:
-papilloedma
-pulmonary oedema
-stroke
What are the 3 endocrine disorders which can increase left atrial pressure leading to pulmonary oedema?
Cushing’s
Conns syndrome
Phaeochromocytoma
How do you treat the pulmonary oedema cause by Conns syndrome?
What is conns syndrome?
Spironolactone
Excess production of aldosterone in the body (Hyperaldosteronism) like a benign tumour in adrenal cortex
How does Conns syndrome affect the body?
Too much aldosterone being produced
Too much sodium retained HYPERNATRAEMIA, leads to patient being very thirsty drinking more leading to HTN
Causes hypokalaemia
What are some restrictive cardiomyopathies that can increase left atrial pressure leading to pulmonary oedema?
Hereditary Haemochromatosis
Sarcoidosis
Amyloidosis
B cell. Lymphoma
Eosiniophilic
What are the deposits in the heart restricting blood flow leading to increase left atrial pressure leading to pulmonary oedema in each of the restrictive cardiomyopathies?
Hereditary Haemochromatosis (iron)
Sarcoidosis (granulomas)
Amyloidosis (proteins)
B cell lymphomas ( tumour infiltrates and fibrosis)
How would a patient with pulmonary oedema due to Left Ventricular Systolic failure (HFrEF) present?
Tachycardia
Tachypnoea
Hypertensive
Reduced sats
Unable to lie down
Tripoding
Pale
Clammy
Distressed
Why does a patient with left ventricular systolic failure (HFrEF) that’s causing pulmonary oedema present as hypertensives, pale, clammy and distressed?
Sympathetic drive leading to vasoconstriction
What is the immediate management /medications that should be given to a patient with left ventricular systolic failure (HFrEF) that’s causing pulmonary oedema?
15L non rebreathe oxygen
IV furosemide
IV opiates
Anti sickness
Nitrates like GTN or IV
What is the dosing of the IV furosemide for a pulmonary oedema caused by left ventricular systolic failure?
40-80mg IV furosemide stat
40mg for loop diuretic naive patients
80mg for patients who have expsoure to loop diuretics
What is the function of the IV furosemide in treating pulmonary oedema caused by left ventricular systolic failure?
Direct vasodilator
(Reduce BP)
What are the 2 different opiates you can give when treating pulmonary oedema caused by left ventricular systolic failure?
Diamorphine (heroin)
Morphine
What are the dosing for the opiates given when managing pulmonary oedema caused by left ventricular systolic failure?
Diamorphine 2.5-5mg IV
Morphine 5-10mg IV
How do opiates act in the treatment of pulmonary oedema caused by left ventricular systolic failure?
Direct vasodilators
Anxiolytics (reducing the stress response calming patient down so less vasoconstriction)
What is the anti sickness medication for when managing pulmonary oedema caused by left ventricular systolic failure?
The opiates
What anti sickness medications would be given when treating pulmonary oedema due to left ventricular systolic failure?
Metoclopramide
Cyclizine
Give the complete management including dosing for medications when managing pulmonary oedema caused by left ventricular systolic failure:
15L non rebreathe oxygen
Furosemide IV 40-80mg stat
Nitrates (GTN 50mg/50ml saline)
Anti emetics (metoclcopramide, cyclizne)
What is the only useful treatment for a patietn with pulmonary oedema due to left ventricular diastolic failure?
CPAP (Continuous Positive Airway Pressure)
What is the benefit of CPAP?
It works in all causes of pulmonary oedema to help relieve the pulmonary oedema (NEED TO TREAT UNDERLYING CAUSE)
