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Acute pulmonary edema is a pathological condition defined by the presence of large amounts of fluid in pulmonary alveoli and in pulmonary interstitium.
Cardiogenic acute pulmonary edema by decreasing blood evacuation from the left atrium: atrial fibrillation, acute mitral regurgitation, mitral stenosis, thrombus or myxoma in the left atrium. Cardiogenic acute pulmonary edema caused by left ventricular diastolic dysfunction: aortic stenosis, hypertension, hypertrophic cardiomyopathy, acute myocardial ischemia. Cardiogenic acute pulmonary edema caused by left ventricular systolic dysfunction: acute myocardial ischemia, myocarditis, dilated cardiomyopathy, heart failure.
Increased capillary permeability (acute respiratory distress syndrome): pneumonia, aspiration syndrome, inhalation of toxic gases, disseminated intravascular coagulation, anaphylaxis shock, acute pancreatitis. Incompletely understood causes: altitude acute pulmonary edema, neurogenic acute pulmonary edema, eclamsie, post anesthesia and post cardio-conversion.
Cardiogenic acute pulmonary edema is caused due to the increase pulmonary capillary pressure from 8-12 mm Hg (normal) to over 18 mm Hg.
The main symptoms of acute pulmonary edema are the shortness of breath, cough, marked anxiety, cold and increased sweating and symptoms of the background heart disease. Dyspnea is very intense, may occur in a patient who had until then no charge of this symptom (for example, a acute pulmonary edema that occurs after the onset of a myocardial infarction), or can overlap with the symptoms of preexisting heart failure . A patient that is restless, anxious or confused with sweaty, pale or mottled skin, with central type cyanosis, the patient is breathing typically standing at the edge of the bed and using accessory respiratory muscles. Marked dyspnea, possibly vesicular murmur and prolonged expiration, rales crackles, of which level increases from the bases of the lungs to tops and can include the entire lung field.
Tachycardia, hypertension or hypotension and, depending on the case, rhythm disturbances or different heart murmurs. In some cases, may appear signs of right heart failure: hepatomegaly, jugular turgor, hepato-jugular reflux, lower limb edema.
Echocardiography can detect the presence of valvulopathies, of thrombus or myxoma in the left atrium, impaired function of the left ventricle. Positive diagnosis of cardiogenic acute pulmonary edema is relatively simple, it is based on patient history and symptoms. General measures: keep the patient in a sitting position, administration of oxygen on mask or nasal tube, dyspnea sedation with morphine.
Furosemide, administrated intravenous in dose of 80-120 mg or more, divided into four doses of 40 mg, each, is the primary mean of treatment of cardiogenic acute pulmonary edema. Nitroglycerin, vasodilator with rapid effect, administrated sublingual (0.5 mg tablets, the dose can be repeated in 5-10 minutes) or intravenously, in the conditions of systolic blood pressure higher than 100 mm Hg. Administration of digoxin can bring benefits by improving the cardiac tonus or by decreasing the heart rate in case of atrial fibrillation. Other therapeutic measures in cardiogenic acute pulmonary edema are: miofilin administration or the administration of angiotensin converting enzyme inhibitors, assisted ventilation, circulatory support with counterpulsation balloon and the treatment of the cause that led to the installation of cardiogenic acute pulmonary edema. Treatment usually focuses on improving respiratory function and dealing with the source of the problem.

Pulmonary edema may be caused either by direct damage to tissue, or a result of a heart or circulatory system malfunction. Pulmonary edema can have cardiac causes, including trouble with the mitral valve or aortic insufficiency.
The most common causes of pulmonary edema are related to problems with the heart, particularly heart abnormalities, heart failure, and heart attack, which is known medically as myocardial infarction. The primary cardiogenic, or heart-related, causes of pulmonary edema include a variety of heart abnormalities that result in an increase in the pulmonary venous pressure.
Heart conditions like congestive heart failure, artery blockages and collapse, heart attack, and valve abnormalities can also be causes. When it comes to the heart valves specifically, some of the biggest causes of pulmonary edema include mitral valve stenosis, mitral valve regurgitation, and aortic insufficiency. Injuries also can be caused by pulmonary contusion, pneumonia, pulmonary embolism and oxygen toxicity, which occurs from breathing high concentrations of oxygen at high atmospheric pressures. Elevations of hydrostatic pressure that can lead to swelling are commonly also caused by increased intracerebral pressure in the brain, which is called neurogenic pulmonary edema.
Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. Cardiogenic acute pulmonary edema is an acute form of heart failure caused by increased pressure in the pulmonary capillary. In severe forms may be present hypercapnia and respiratory acidosis, which constitute signs of gravity. Its beneficial effects are explained by the occurrence of venous dilation, which will lead to decreased preload (quickly installed) and diuresis (which occurs in 20-90 minutes after the administration of furosemide). Digoxin administration is contraindicated in cardiogenic acute pulmonary edema associated with mitral stenosis or with acute myocardial infarction.
Pulmonary edema is an abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.
Artery blockage problems known as myocardial ischemia are often included on this list, too. This increase shifts the delicate balance between the interstitial tissue and the pulmonary capillaries. These problems often result in volume overloads of the left ventricle, which causes an imbalance when it comes to how much blood is pumped to the lungs and how well they are oxygenated . Ventricular septal defects, which are holes within the cardiac muscle separating the two lower chambers of the heart, can also be problematic. A lung that collapses is an extreme example, but even severe bruising or scarring can cause a collection of blood and lung fluids to pool. Some of the most common symptoms of injury-related edema include extreme bouts of shortness of breath, particularly when lying down, and a bluish pallor to the skin. For example, high altitude pulmonary edema (HAPE) is an acute mountain illness that occurs when persons ascend to high elevations without proper acclimation.

Air pollution can also be a cause, particularly in children and particularly in places where the air quality is generally bad to start with.
These are usually serious conditions and can include sepsis, disseminated intravascular coagulation (DIC), and pancreatitis.
Some chemical causes of pulmonary edema include radiographic contrast allergies, salicylate intoxication and inhaled toxins, such as occurs in smoke inhalation.
The heart and lungs are connected in a number of important ways, and when the heart isn’t working properly it can impact how much blood is pumped in and out of the lungs — which, in turn, can cause or worsen fluid build-up problems.
This fluid is often blood, but it can also be water, lymphatic fluid, mucus, or a combination of some or all of these. When this happens, the hydrostatic pressure elevates, promoting the collection of fluid into the capillaries and thereafter into the alveoli. Edema increases inside the lungs from leakage of proteins through damaged capillary linings.
Of all the causes of this condition, HAPE has the simplest treatment: people usually need only to descend to lower altitudes to get things re-stabilized.
Multiple transfusions with negative reactions can also lead to fluid and swelling, as can trauma to other parts of the body that may seem unrelated. It is due to either failure of the left ventricle of the heart to adequately remove blood from the pulmonary circulation ("cardiogenic pulmonary edema"), or an injury to the lung parenchyma or vasculature of the lung ("noncardiogenic pulmonary edema"). These aren’t the only potential causes of edema, though; lung injury and trauma are also high on the list.
The extent of the pulmonary edema depends on osmotic and hydrostatic forces within the pulmonary capillaries.
Alveoli are tiny air sacs that easily fill with fluid, resulting in shortness of breath and coughing. Fluid follows the leaking proteins due to oncotic forces causing a dysfunction of the surfactant-lined alveoli. If the injury is bad enough, problems can travel through the blood to many different places. Blood issues, including pancreatitis and bad reactions to transfusions, are also possibilities, as are environmental factors like heavy air pollution or reduced oxygen levels, particularly at high altitudes.
Extended time on cardiopulmonary bypass during surgeries can also sometimes lead to lung edema. Anyone who is experiencing difficulty breathing, is vomiting blood, or who experiences periodic bursts of intense difficulty breathing should usually get medical attention as soon as possible.

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