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  • • 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

Eastridge BJ et al: Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma 2007;63:291.  [PubMed: 17693826]
Finfer S et al: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247.  [PubMed: 15163774]

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