Article Contents ::
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.
- Myocardial infarction (MI)
- Diabetes mellitus (DM)
- Coronary heart disease
- Valvular heart disease
- Reexpansion of lung after injury
- High altitude
- Neurologic diseases
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
- Cardiomyopathy Aortic dissection
- Pulmonary embolization Severe MS
- Severe AS
- Severe AR
- Severe MR
- Beta blocker overdose
- Cardiac tamponade.
Investigations for Pulmonary Edema
- Blood tests
- Chest X-ray
- 2D echo
- Doppler studies
- Pulmonary artery catheterization
- Left heart catheterization
- Coronary angiography.
Treatment of Pulmonary Edema
- Propped up position
- Treatment of hypoxaemia, acidosis
- Treatment of MI
- Endotracheal intubation
- Treat hyperglycemia
- Treat arrhythmias
- Nitroglycerine, Isosorbide dinitrate
- 2 – 10 mg IV ACE inhibitors
- Norepine hrine
- 2 to 4 to 15 g/min.
- 2 to 10 IJg/kg/min
- Maximum 50 lJg/kgjmin
- – 2.5 to 10 IJg/kg/min
- Xanthines-aminophylli ne Aortic counterpulsation Ventricular assist devices Cardiac transplantation Reperfusion therapy.