Cardiogenic pulmonary edema: who is at risk, how to recognize and help

In the human body, everything is interconnected: therefore it is not surprising that a serious pathology of the heart entails serious complications from the respiratory system.

Cardiogenic( or hemodynamic) pulmonary edema occurs precisely as a result of a malfunction in the cardiovascular system. This pathological condition with a high risk of death, but not hopeless - the main thing in time to identify it and if possible to prevent the inevitable consequences.

  • 4 Contents
    • 1 Contents and Description
      • 1 Description and Statistics
      • 2 Causes and Risk Factors
      • 3 Classification than differs from non-cardiogenic
      • 4 Danger and Complications
      • 5 Symptoms and Signs
      • 6 Diagnosis
      • 7 Tactics of Treatment and First Aid
      • 8 Forecasts and Prevention
  • Description and Statistics


    Cardiogenic pulmonary edema always iscomplication of heart disease :

    • acute myocardial infarction - in 60% of cases;
    • of chronic heart failure - in 9%;
    • arrhythmias - in 6%;
    • of acquired and congenital malformations - in 3%.

    As a result of stagnant phenomena in a small circle of blood circulation, the outflow of blood and lymph from the vessels is disturbed, and the liquid transudate penetrates through the capillary walls into the lung tissue.

    Normally, the lungs consist of a multitude of minute, air-filled vesicles - the alveoli. If liquid starts to accumulate in them - because of sweating it from the circulatory and lymphatic system - there is a pulmonary edema.

    Causes and Risk Factors

    If a person has any severe cardiovascular disease - his heart wears and ceases to cope with his functions, the most important of which is the pumping one.

    In this case, the heart muscle weakens so much that it stops fully circulating blood through the system of blood vessels. There is stagnation of blood in the small or pulmonary circulatory system , which leads to the fact that the liquid from the capillaries and lymph vessels begins to penetrate through their walls into the pulmonary alveolar vesicles - a so-called fluid effusion occurs.

    Liquid transudate expels air from the alveoli and replaces it with - because of this, the respiratory capacity of the lungs is significantly reduced.

    The situation is exacerbated as the amount of transudate in the lungs increases - the effect of "internal drowning" is observed, when the lungs are filled with water and can not function fully.

    As a result breathing becomes almost impossible , oxygen does not enter the blood, there is oxygen starvation of the whole organism and death.

    Depending on the underlying cause, types of cardiogenic pulmonary edema are distinguished, due to:

    • with insufficient contractility of the left ventricle( with infarction or coronary insufficiency);
    • with left ventricular overload( with mitral or aortic valve insufficiency);
    • increase in pressure in a large circle of blood circulation as a result of hypertensive crisis;
    • blockade of normal blood flow to the heart due to the presence of hematoma, thrombus, tumor or stenosis of the valve.

    Risk factors for the development of cardiogenic pulmonary edema are:

    • chronic cardiac overload due to hypoxia, anemia, stress;
    • age over 40 years;
    • any chronic cardiovascular disease.

    Classification than is different from non-cardiogenic

    Cardiogenic and noncardiogenic pulmonary edema are very similar in their clinical manifestations, but recognizing and distinguishing them from each other is an important medical problem, since the principles of treating these two pathologies differ.

    Comparison criteria Cardiogenic edema Noncardiogenic edema
    History of Cardiovascular pathology Cardiovascular pathology is not present
    Root cause of Circulatory disturbance and increased intravascular pressure Increase in vascular wall permeability and decrease in extraovascular pressure in lungs
    Topdiseases Usually gradual: attacks occur and worsen by the type of cardiac asthma Sudden
    Characteristic simp
    • attacks of night suffocation
    • nocturnal asphyxiation attacks
    • impossibility to sleep in horizontal position
    • peripheral edema
    • swollen veins on neck
    • enlarged and dense liver
    • limbs usually cold
    • characterized by pains in the heart area
    • abruptly arising and rapidly aggravated shortness of breath, rapid breathing
    • cough with foamy sputum
    • orthopnea
    • extremities usually warm
    • pains in the heart area are uncharacteristic
    Radiography The heart is enlarged in size, there are signs of pleuralof exudate, swelling distributed centrally or uniformly normal-sized heart, signs of pleural effusion no edema is distributed along the periphery or spots
    data transthoracic echocardiography heart chambers expanded. The function of the left ventricle is reduced. The normal size of the heart chambers. The function of the left ventricle is normal.
    Pulmonary catheterization results Pulmonary artery pressure is greater than 18 mm Hg. The pressure in the pulmonary artery is less than 18 mm Hg.

    In the development of cardiogenic pulmonary edema, is allocated 4 consecutive clinical stages:

    • dyspneaatic - breathing is difficult, many dry wheezes, a dry cough appears;
    • orthopedic - wheezing and coughing become damp, breathing is difficult and rapid;
    • acute clinical - wet wheezing is audible without special listening of the chest; in the horizontal position the patient starts to choke, during the cough a large amount of sputum is released;
    • severe - progresses cyanosis of the skin and mucous membranes, cough unceasing with copious foam, the patient is covered with cold sweat, wet rales and gurgling are heard in his chest.

    Clinical variants of cardiogenic pulmonary edema:

    • Interstitial pulmonary edema, which in its manifestations resembles cardiac asthma. Attacks of the disease usually happen at night, accompanied by severe suffocation and lack of air. They last from several minutes to several hours, after which there is an improvement.
    • Alveolar pulmonary edema. This is an acute condition that does not stop on its own. A bubbling cough with abundant foamy sputum is characteristic. Asphyxia and death in this case can occur very quickly. Often, alveolar edema complicates the course of interstitial edema.

    Danger and complications

    As a result of lung edema, the entire body suffers, because the internal organs lack oxygen and develop ischemic events.

    Within 4-5 minutes after the onset of a severe attack of suffocation can begin to die from hypoxia of the brain cell, which will inevitably lead to death.

    Non-fatal, but very dangerous complications of pulmonary edema are:

    • ischemic injury of the adrenal, liver and kidney;
    • pneumosclerosis - scarring of lung tissue;
    • atelectasis or pulmonary congestion;
    • congestive pneumonia - a secondary inflammation of the lungs against a background of circulatory disturbances in them;
    • emphysema - a pathological change in the structure of bronchioles and alveoli;
    • recurrent pulmonary edema.

    Symptoms and signs

    Symptomatic of this condition is accompanied by the following manifestations:

    • dyspnea and shortness of breath, aggravated in prone position;
    • asphyxiation and lack of air;
    • fear of death;
    • bulging eyes and open mouth;
    • pain in the region of the heart;
    • abundant sweat;
    • frequent shallow breathing;
    • increasing skin pallor and blueing of mucous membranes;
    • feeling of compression and discomfort in the lungs during inspiration;
    • cough: initially dry, then moist with abundant foamy sputum;
    • can be difficult not only to inhale, but also to exhale - especially this is characteristic of interstitial edema;
    • progressive wheezing in the lungs, which are audible in the severe stage without auscultation;
    • lowering blood pressure and barely palpable pulse on the limbs.
    At the first symptoms, you should immediately consult a doctor - call an ambulance.

    Even if such seizures have happened before, but passed independently for several hours - do not expect that you can continue to do without medical assistance. At any time, pulmonary edema can instantly become a deadly and non-curable condition.

    Diagnosis

    The diagnosis of "pulmonary edema" can be made on the basis of a characteristic clinical picture and auscultation data of the patient. But for the determination of cardiogenic edema, a number of additional diagnostic measures will be required:

    • anamnesis study to identify severe cardiovascular pathologies;
    • transthoracic echocardiography;
    • chest X-ray;
    • pulmonary catheterization.

    Tactics of treatment and emergency care

    Treatment is carried out in a hospital, its main tasks:

    • pressure reduction in the pulmonary circulation;
    • improved left ventricular function;
    • saturation of blood with oxygen;
    • prevention of severe irreversible complications, control of ischemia of internal organs.

    To this end, the following treatment methods are used:

    • Morphine anesthesia.
    • Oxygen inhalations. In severe hypoxia, the patient is transferred to the artificial ventilation of the lungs.
    • In case of abundant foam formation in the lungs, defoamer is produced by inhalation of 30% alcohol.
    • Stimulation of urination with diuretics.
    • Assign nitroglycerin sublingually or intravenously to increase pumping function of the heart.
    • Reduction of blood pressure with the help of antihypertensive drugs or ganglion blockers.
    • Normalization of the heart rhythm with cardiac glycosides( Strofantin, Digoxin) and beta-blockers( Propranolol).In emergency cases, emergency electropulse therapy is possible.
    • To prevent bronchospasm, intravenously injected with Eufillin. This medicine is not used for cardiogenic edema caused by myocardial infarction.

    Treatment is considered effective if: the

    • patient can take a horizontal position without the risk of suffocation;
    • there are no audible wet wheezes;
    • skin and mucous membranes acquire a normal color;
    • dyspnea becomes much less intense.

    Prognosis and prevention measures


    Lethal outcome for cardiogenic pulmonary edema occurs in every fifth patient. Basically, these are elderly people who have developed swelling with lightning or developed gradually, but did not follow the doctor in time.

    If the edema develops as complications of acute myocardial infarction - the forecast is less favorable: 9 out of 10 patients die.

    The only possible prevention of cardiogenic pulmonary edema is the timely treatment of all cardiac pathologies, the immediate relief of all harbingers of the onset pulmonary edema.

    Important for such patients is compliance with salt-free diet, moderate movement activity and medical therapy under the supervision of the attending physician.

    If the pathology of the heart does not stop drug-induced - should consider the question of surgical correction of it .

    For the core patient, the main thing is not to bring yourself to the point where pulmonary edema may begin at any moment, which, if the situation coincides, will take the life of the patient literally in a matter of minutes.

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