Pulmonary oedema Flashcards
1
Q
What is pulmonary oedema ?
A
- This is an accumulation of fluid in the lung specifically the Interstitium & Alveolar spaces
- It occurs when the filtration of fluid exceeds the ability of the lymphatics to clear the fluid.
2
Q
What are the 2 main types of pulmonary oedema ?
A
- Cardiogenic (or hydrostatic) pulmonary oedema - caused by an elevated pulmonary capillary pressure from left-sided heart failure.
- Non-cardiogenic pulmonary oedema - caused by altered alveolar-capillary membrane permeability - eg, acute respiratory distress syndrome (ARDS), lymphatic insufficiency, pneumonia
3
Q
What are the signs/symptoms of acute pulmonary oedema ?
A
Signs:
- Severely breathless, sweaty, nauseated and anxious.
- Initially they may have a dry or productive cough (sometimes with pink, frothy sputum).
- Patients may also develop paroxysmal nocturnal dyspnoea or orthopnoea.
Signs:
- The patient is in respiratory distress, pale, sweaty, tachypnoeic and tachycardic.
- They may be cyanosed, have evidence of congested neck veins and a raised JVP.
- Basal/widespread rales or fine crackles are usually heard when listening to the chest.
- Oxygen saturation is usually <90% on room air.
- Assess for a gallop rhythm (3rd heart sound) and murmurs suggestive of valve stenosis or regurgitation.
- Hypotension - the triad of hypotension (systolic blood pressure <90 mm Hg), oliguria, and low cardiac output is known as cardiogenic shock.
- In hypertensive heart failure, a high blood pressure, tachycardia and vasoconstriction present with signs of pulmonary oedema without extensive systemic congestion.
- Where pulmonary oedema occurs in association with right heart failure, hepatomegaly and peripheral oedema are usual.
4
Q
What are the investigations and management of pulmonary oedema ?
A
See acute heart failure notes
