Pulmonary Edema
Pulmonary Edema is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Imbalance in Starling forces causes an accumulation of alveolar fluid secondary to leakage from pulmonary capillaries into the interstitium and alveoli of the lungs.Description
- Cardiogenic:
- Abnormality in cardiac function leading to inadequate tissue perfusion
- Acute decompensated cardiac failure: Acute fluid overload in the setting of chronic HF
- Acute vascular failure: Decreased contractility and increased vascular resistance
- Noncardiogenic:
- Increased alveolar–capillary membrane permeability, and accumulation of fluid in the alveoli without a cardiac etiology
- Acute lung injury: Lower severity
- Acute respiratory distress syndrome (ARDS): PaO2/FiO2 ratio of ≤200 mm Hg
- New York Heart Association classification:
- Class I: Not limited in normal physical activity by symptoms
- Class II: Ordinary physical activity results in fatigue, dyspnea, or other symptoms
- Class III: Marked limitation in normal activity
- Class IV: Symptoms at rest or with any activity
- Epidemiology:
- 5.8 million patients in US
- Increases with increasing age and affects 10% of population >75 yr.
- 30–40% of patients with HF are hospitalized every year.
- 11% 1 mo mortality after AHF admission
Etiology
Etiology
- Cardiogenic etiologies:
- Contractile dysfunction:
- Ischemic heart disease
- Idiopathic cardiomyopathy
- Myocarditis
- Systolic pressure overload:
- Aortic stenosis
- Systemic hypertension
- Systolic volume overload:
- Aortic regurgitation
- Mitral regurgitation
- Restricted diastolic filling:
- Mitral stenosis
- Left atrial myxoma
- Hypertrophic cardiomyopathy
- High-output states:
- Hyperthyroidism
- Anemia
- Arteriovenous fistula
- Wet beriberi
- Congenital heart disease
- Endocarditis
- Rheumatic heart disease
- Contractile dysfunction:
- Noncardiogenic etiologies:
- Sepsis
- Acute pulmonary infection, aspiration
- Inhalation injuries
- Aspiration
- Near drowning
- Disseminated intravascular coagulation
- Pancreatitis
- Pulmonary contusion
- Severe (nonthoracic) trauma
- Cardiopulmonary bypass
- Uremia
- High-altitude pulmonary edema
- Neurogenic pulmonary edema
- Narcotic overdose
- Salicylate overdose
- Pulmonary embolism
- Fat embolism
- Transfusion-related acute lung injury
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Citation
* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Pulmonary Edema
ID - 307418
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307418/all/Pulmonary_Edema
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -