cardiogenic pulmonary edema (CPE)
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Etiology
- left ventricular failure (congestive heart failure)
- obstruction of flow through the mitral valve
Precipitating factors:
- severe hypertension
- myocardial ischemia or infarction
- acute mitral regurgitation
- new onset arrhythmias
- volume overload in the setting of left ventricular dysfunction
- correction of precipitating event may be necessary for resolution of pulmonary edema
Pathology
(see pulmonary edema)
Clinical manifestations
- symptoms:
- usually rapid in onset
- dyspnea
- air hunger
- anxiety
- restlessness
- signs
- decreased peripheral perfusion
- pulmonary congestion
- use of accessory respiratory muscles
- wheezes
- expectoration of pink, frothy fluid
- cardiomegaly
- third heart sound (S3)
Laboratory
Diagnostic procedures
- pulmonary artery catheter for pulmonary capillary pressure
- facilitates differentiation of cardiogenic vs. other cause of pulmonary edema
- allows hemodynamic monitoring during therapy Radiography:
- cardiomegaly
- interstitial & perihilar vascular engorgement
- Kerly B lines
- pleural effusion
- radiographic changes may lag behind development of symptoms
- resolution of radiographic changes may not coincide with clinical improvement
Management
- Supportive therapy
- oxygen
- non-invasive positive pressure ventilation[5][7]
- CPAP & non-invasive pressure support ventilation reduce hypoxemia, mortality & need for endotracheal intubation[3][4][6][7]
- BiPAP may be better
- mechanical ventilation
- hypercapnia
- inadequate oxygenation on non-rebreathing face mask
- sitting position
- improves pulmonary function
- assists venous pooling
- reduce cardiac workload
- Pharmacologic therapy
- morphine
- diuresis, furosemide
- venodilator
- decreases pulmonary congestion within minutes of IV infusion
- begin 20-40 mg IV
- increase for response up to 200 mg IV
- nitroglycerin
- venodilator
- may potentiate effect of furosemide
- begin 5 ug/min, titrate to effect
- inotropic agents
- may be useful as secondary agents
- dobutamine
- vasodilator agent for afterload reduction
- Mechanical reduction of pulmonary congestion
- hemodialysis
- ultrafiltration
- phlebotomy
- rotating tourniquets to reduce venous return
- Correction of precipitating factors
More general terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 130-31
- ↑ 2.0 2.1 Ray P, Arthaud M, Birolleau S, Isnard R, Lefort Y, Boddaert J, Riou B; the EPIDASA Study Group. Comparison of brain natriuretic Peptide and probrain natriuretic Peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. J Am Geriatr Soc. 2005 Apr;53(4):643-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15817011
- ↑ 3.0 3.1 Masip J et al, Noninvasive ventilation in acute cardiogenic pulmonary edema: Systematic review and meta-analysis. JAMA 2005 Dec 28; 294:3124-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16380593
- ↑ 4.0 4.1 Peter JV et al, Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: A meta-analysis Lancet 2006; 367:1155 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16616558
- ↑ 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 14, 17, 19 American College of Physicians, Philadelphia 2006, 2015, 2022
- ↑ 6.0 6.1 The NNT: Non-Invasive Positive Pressure Ventilation for Acute Pulmonary Edema. http://www.thennt.com/nnt/non-invasive-positive-pressure-ventilation-for-pulmonary-edema/
Masip J, Roque M, Sanchez B et al Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005 Dec 28;294(24):3124-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16380593 - ↑ 7.0 7.1 7.2 Berbenetz N, Wang Y, Brown J et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev 2019 Apr 5; 4:CD005351. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30950507 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005351.pub4/full