Manifestations of Cardiogenic Pulmonary Edema
Apr 29, 2019
Source: Cainiu Health
Dr. Yuan Xiaoying
Introduction
Clinical manifestations of cardiogenic pulmonary edema: sudden onset of dyspnea, palpitations, shortness of breath, restlessness, severe orthopnea (inability to lie flat), and cough productive of frothy sputum—severe cases may produce 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 of the lungs.
Prevention: During the febrile phase and hypotensive shock phase, intravenous fluid administration should be carefully titrated and kept within appropriate limits.
Pathogenesis of cardiogenic pulmonary edema: myocardial injury, hypervolemia, and hypertension; heart failure with impaired myocardial contractility leading to inadequate left ventricular ejection, resulting in elevated pulmonary arterial pressure and increased pulmonary capillary hydrostatic pressure. This causes transudation of intravascular fluid into the pulmonary interstitium and alveoli, culminating in pulmonary edema.
Clinical manifestations: sudden onset of dyspnea, palpitations, shortness of breath, restlessness; severe cases may be unable to lie flat and may produce frothy sputum—pink frothy sputum in critical cases.
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, intravenous fluid administration should be carefully titrated to avoid hypervolemia during the oliguric phase caused by massive reabsorption of interstitial fluid; during the oliguric phase, fluid therapy should follow the principle of “better less than more.” Treatment: oxygen therapy, sitting position, strict restriction of fluid intake volume and rate to reduce cardiac preload; diuretics, cathartics, positive inotropic agents, vasodilators, and blood purification therapies.
