Cardiogenic pe

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Cardiogenic pe

  1. 1. CardiogenicPulmonary Edema
  2. 2. Overview • Increased hydrostatic pressure (pulmonary vein). • Secondary to cardiac dysfunction • Multiple etiologies.
  3. 3. Etiology • Atrial outflow obstruction • Mitral stenosis • Left Ventricular Systolic Dysfunction • Congestive Heart Failure • Cardiomyopathy • Left Ventricular Diastolic Dysfunction • Ischemia • Others • Dysrhythmias • MI • Ventricular outflow obstruction- Aortic Stenosis
  4. 4. Presentation • Sudden SOB, anxiety, feeling of drowning • Frothy pink sputum • Less frequent gradual onset • Dyspnea on exertion • Orthopnea • DNP
  5. 5. Presentation • Tachypnea and tachycardia • Anxious • Diaphoretic • Air hunger • Sitting upright • Hypertension / hypotension • Crackles on auscultation • JVD • S3 sound
  6. 6. Differential Diagnosis • Acute Respiratory Distress Syndrome • Asthma • Cardiogenic Shock • Chronic Obstructive Pulmonary Disease • Emphysema • Goodpasture Syndrome • Myocardial Infarction • Pneumocystis jiroveci Pneumonia • Pneumonia,
  7. 7. Workup • CBC anemia pneumonia • BNP • Electrolytes-diuretic use • BUN creatinine • Pulsoximetry • ABG • EKG LA enlargement and LV hypertrophy
  8. 8. Workup • Chest X-ray • Enlarged heart • Kerley lines • Basilar edema (vs diffuse edema) • Absence of air bronchograms • Presence of pleural effusion (particularly bilateral and symmetrical pleural effusions)
  9. 9. Treatment • Ventilatory Support • Non invasive ventilation CPAP/ BIPAP • Decrease LOS, intubation, costs • Intubation. Hypoxic on NIPV Hemodynamic unstable • Preload reduction • Nitroglycerin / Nesiritide / Morphine / Diuretics • Afterload reduction • ACE inhibitors / ARB / Nitroprusside • Inotropic support • Catecholamines • Phosphodiesterase inhibitors • IABP / Ultrafiltration
  10. 10. Prognosis • Difficult to estimate • Great Variability • Mortality 10-15%

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