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.
  • 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

  • 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
  • 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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