Manifestations of Cardiogenic Pulmonary Edema

Pathogenesis of cardiogenic pulmonary edema: myocardial injury, hypervolemia, and hypertension; heart failure with impaired left ventricular contractility leading to inadequate ejection of blood from the left ventricle; elevated pulmonary arterial pressure and increased pulmonary capillary hydrostatic pressure; transudation of intravascular fluid into the pulmonary interstitium and alveoli, resulting in pulmonary edema.

Clinical manifestations: sudden onset of dyspnea, palpitations, shortness of breath, restlessness; in severe cases, orthopnea and coughing up pink frothy sputum.

Physical signs: cyanosis of the lips, jugular venous distension and engorgement, accentuated heart sounds, tachycardia, elevated blood pressure, and bilateral dry and wet rales on auscultation.

Prevention: during the febrile phase and hypotensive shock phase, administer intravenous fluids judiciously to avoid hypervolemia caused by massive reabsorption of interstitial fluid during the oliguric phase; during the oliguric phase, adhere to the principle of “better less than more” when administering intravenous fluids.

Treatment: oxygen therapy, sitting position, strict control of fluid intake volume and infusion rate to reduce cardiac preload and afterload; diuretics, cathartic therapy, positive inotropic agents, vasodilators, and blood purification therapies.