Pulmonary Oedema Flashcards
What is acute heart failure?
Occurs with the rapid onset of symptoms and signs of heart failure secondary to abnormal cardiac function, causing elevated cardiac filling pressures. This causes severe dyspnoea and fluid accumulates in the interstitium and alveolar spaces of the lung (pulmonary oedema)
What are symptoms of acute pulmonary oedema??
- Dyspnoea
- Orthopnoea
- PND
- Pink frothy sputum
What are signs of acute pulmonary oedema?
- Distressed/Pale/sweaty
- Tachycardia
- Tachypnoea
- Pulsus alternans
- Increased JVP
- Fine bi-basal crackles
- Gallop rythm
- Wheeze - cardiac asthma
- Sitting up and leaning forward
What is the main feature of acute heart failure?
Acute pulmonary oedema
What are classes of causes of acute heart failure?
- IHD/MI - papillary muscle rupture or VSD
- Valvular disease - regurgitation in endocarditis or prosthetic valve thrombosis
- Hypertension - episodes of ‘flash’ pulmonary oedema
- AKI/CKD - fluid overload and a reduced renal excretion
- Atrial fibrillation
What are the different syndromes of acute heart failure?
- Acute decompensated HF
- Hypertensive AHF
- Acute pulmonary oedema
- Cardiogenic shock
- High output heart failure
- Right heart failure
What would other differentials should you consider in someone presenting with symptoms of acute pulmonary oedema?
- Asthma/COPD
- Pneumonia
How would you assess someone with acute pulmonary oedema?
- ECG
- CXR
- ECHO
- Bloods - BNP, U+E’s, Troponin, ABG, LFTs, albumin, total protein
What are you looking for on ECG in someone with acute pulmonary oedema?
- ACS
- LVH
- AF
- Valvular heart disease
- LBBB
What might you see on CXR in someone with acute HF?
- Alveolar oedema - Bat wings
- Kerley B lines (interstitial oedema)
- Cardiomegaly
- Dilated upper lobe vessels
- Pleural Effusion
What might you see on ABG in acute pulmonary oedema?
- Decreased PaO2
- Decreased PaCO2 (hyperventilation), or increased PaCO2 (severe oedema)
When performing a CXR for investigating acute pulmonary oedema, what would you want to exclude?
- Pneumothorax
- PE
- Coonsolidation - pneumonia
Why would you investigate total protein and serum albumin in someone with acute pulmonary oedema?
Look for hypoalbuminaemia - reduced oncotic pressure leading to pulmonary oedema
What are signs of pulmonary oedema on CXR?
- Bilateral shadowing
- Costophrenic effusions
- Fluid in the lung fissures
- Kerley B lines
- Prominent upper lobe vessels
What is the initial treatment for acute pulmonary oedema?
PODIMAN - for all treatments to consider using - use “-MAN” part in specific situations
- Positioning - sit upright
- Oxygen
- IV Diuretics + fluid restriction
- IV access - send bloods
- Morphine*
- Anti-emetic*
- Nitrates*
*GTN infusion if SBP >110, or 2 puffs GTN spray if SBP >90 in crashing pulmonary oedema
*Only use morphine in distressed patients - should not be routinely offered in acute heart failure/pulmonary oedema (as per NICE guidelines)