Pulmonary Edema, Cardiogenic

• • Hypoxemia

  • Rales

Epidemiology

• • Post-myocardial infarction patients can present with pulmonary edema

  • Surgical stress or fluid shifts in patients with underlying coronary artery disease

  • Fluid overload

Symptoms and Signs

• • Hypoxemia

  • Shortness of breath

  • Rales

  • Presence of third heart sound

Laboratory Findings

• • Elevated pulmonary arterial wedge pressures on pulmonary artery catheterization

Imaging Findings

• • Chest x-ray

  • -Cephalization of blood flow

    -Kerley B lines

    -Perihilar infiltrates

• • Diagnosis often requires the combination of physical exam and invasive monitoring findings

  • Causes can include arrhythmia or muscle failure as the underlying cause of the cardiac dysfunction

• • Physical exam

  • ABG measurements

  • Chest x-ray

• • Minimize fluid intake

  • Minimize salt intake

  • Diuresis

  • Supplemental oxygen

  • Intubation and mechanical ventilation

Medications

• • Diuretics

  • Inotropes (rarely indicated)

Treatment Monitoring

• • Fluid balance

  • Serial ABG measurements

  • Symptomatic improvement

  • Monitor pulmonary capillary wedge pressure (PCWP)

  • Serial chest films

Complications

• • Pneumonia

Prognosis

• • Determined by etiology of cardiac insufficiency

Prevention

• • Careful attention to fluid balance

References