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    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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    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 -