5 minute presentation

1. Cardiogenic
Pulmonary Edema

2. Overview
• Increased hydrostatic pressure (pulmonary vein).
• Secondary to cardiac dysfunction
• Multiple etiologies.

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. Presentation
• Sudden SOB, anxiety, feeling of drowning
• Frothy pink sputum
• Less frequent gradual onset
• Dyspnea on exertion
• Orthopnea
• DNP

5. Presentation
• Tachypnea and tachycardia
• Anxious
• Diaphoretic
• Air hunger
• Sitting upright
• Hypertension / hypotension
• Crackles on auscultation
• JVD
• S3 sound

6. Differential Diagnosis
• Acute Respiratory Distress Syndrome
• Asthma
• Cardiogenic Shock
• Chronic Obstructive Pulmonary Disease
• Emphysema
• Goodpasture Syndrome
• Myocardial Infarction
• Pneumocystis jiroveci Pneumonia
• Pneumonia,

7. Workup
• CBC anemia pneumonia
• BNP
• Electrolytes-diuretic use
• BUN creatinine
• Pulsoximetry
• ABG
• EKG LA enlargement and LV hypertrophy

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. 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. Prognosis
• Difficult to estimate
• Great Variability
• Mortality 10-15%