Pulmonary Edema Causes Diagnosis with Treatment

Edema is defined as a palpable swelling produced by expansion of the interstitial fluid volume. When the left ventricle is not able to eject all the blood effectively there is pulmonary conges­tion, systemic hypoperfusion, and exudation of fluid and blood elements into the alveoli; this is called Pulmonary edema.

• Fluid from the pulmonary vasculature leaks into the interstitium and alveoli of the lung.
• Fluid accumulation occurs when there is an imbalance of hydrostatic and oncotic pressures within the pulmonary capillaries and in the surrounding tissue.
• Commonest cause of pulmonary edema is left ven­tricular dysfunction.
• Left ventricular dysfunction leads to decreased per­fusion of the systemic circulation, so there is :
• Fall in cardiac output/cardiac index to less than 2,2 L/min/m²•
• Systolic blood pressure <90 mmHg.
• Pulmonary capillary wedge pressure> 18 mmHg.
• All these features comprise cardiogenic shock.
• Cardiogenic shock is a fall in systemic perfusion pressure with circulatory failure, leading to shock.

Pulmonary Edema Risk Factors

• Cardiogenic

  • HTN
  • Myocardial infarction (MI)
  • Diabetes mellitus (DM)
  • Smoking
  • Coronary heart disease
  • Valvular heart disease

• Noncardiogenic

  • Sepsis
  • Reexpansion of lung after injury
  • High altitude
  • Burns
  • Neurologic diseases
  • Medications

Etiology of Cardiogenic shock and Pulmonary edema

• Acute myocardial infarction Ventricular septal rupture Papillary muscle rupture
•  Rupture of Cordae tendinae Tachya rrhyth mias Bradyarrhyth m ias
• Myocarditis
• Cardiomyopathy Aortic dissection
• Pulmonary embolization Severe MS
• Severe AS
• Severe AR
• Severe MR
• Beta blocker overdose
• Cardiac tamponade.

Investigations for Pulmonary Edema

• Blood tests
• ECG
• Chest X-ray
• 2D echo
• Doppler studies
• Pulmonary artery catheterization
• Left heart catheterization
• Coronary angiography.

Treatment of Pulmonary Edema

• inhalation
• Propped up position
• Treatment of hypoxaemia, acidosis
• Treatment of MI
• Endotracheal intubation
• Treat hyperglycemia
• Treat arrhythmias
• Nitroglycerine, Isosorbide dinitrate
• Diuretics
• Morphine
  • 2 – 10 mg IV ACE inhibitors
• Digitalis
• Norepine hrine
  • 2 to 4 to 15 g/min.
• Dopamin
  • 2 to 10 IJg/kg/min
• Maximum 50 lJg/kgjmin
• Dobutamine
  • – 2.5 to 10 IJg/kg/min
• Xanthines-aminophylli ne Aortic counterpulsation Ventricular assist devices Cardiac transplantation Reperfusion therapy.