Pulmonary Edema: Cardiogenic vs Noncardiogenic, Radiology, Lab Markers, and Management

Flashcards covering radiologic findings, pathophysiology, biomarkers, and management of pulmonary edema, including distinctions between cardiogenic and noncardiogenic etiologies.

Pulmonary edema

Excess fluid in the lungs causing impaired gas exchange; can be cardiogenic (heart-related) or noncardiogenic (nonheart-related) in origin.

Cardiogenic pulmonary edema

Pulmonary edema due to left-sided heart failure with elevated pulmonary hydrostatic pressure and fluid transudation; often with cardiomegaly and specific radiographic clues.

Noncardiogenic pulmonary edema

Pulmonary edema from alveolar–capillary membrane permeability problems or inflammatory/injury processes; infiltrates near the hilum, usually without pleural effusion and without an enlarged cardiac silhouette.

Bat's wing pattern (butterfly pattern)

Central perihilar shadowing with peripheral lungs relatively clear; characteristic radiographic distribution in severe cardiogenic edema.

Kerley A lines

Long interstitial lines radiating from the hila, indicating interstitial edema.

Kerley B lines

Short horizontal interstitial lines near the pleural surfaces, often at the lung bases, indicating edema.

Cardiomegaly

An enlarged heart on chest radiograph, commonly seen in congestive heart failure.

BNP (brain natriuretic peptide)

Hormone produced by the heart; elevated BNP supports heart failure; normally <100 pg/mL in healthy individuals.

BNP levels interpretation

BNP

Preload reduction

Decrease in venous return to the heart to lower pulmonary capillary pressure; achieved with agents like nitroglycerin, loop diuretics, and sometimes morphine.

Afterload reduction

Decrease in systemic vascular resistance to improve cardiac output; achieved with vasodilators and ACE inhibitors such as captopril, enalapril, and nitroprusside.

Positive inotropic agents

Drugs that increase myocardial contractility to boost cardiac output; examples include dobutamine, dopamine, norepinephrine, and milrinone.

Nitroglycerin

A preload-reducing vasodilator used to decrease venous return and edema; rapid-acting and commonly employed in cardiogenic edema.

Furosemide

Loop diuretic that reduces preload via diuresis and provides vasodilation; a cornerstone in treating cardiogenic edema.

Nitroprusside

Potent vasodilator that mainly reduces afterload (and to some extent preload); used to improve hemodynamics in cardiogenic edema.

Enalapril

ACE inhibitor that lowers angiotensin II levels, causing vasodilation and reduced afterload; improves cardiac output.

Captopril

ACE inhibitor that prevents conversion of angiotensin I to II; potent afterload reducer contributing to improved hemodynamics.

Milrinone

Positive inotrope and vasodilator (inodilator) that reduces afterload and preload while increasing cardiac output.

Dopamine

Catecholamine with dose-dependent effects: low doses promote renal/splanchnic vasodilation and diuresis; higher doses increase contractility; very high doses raise afterload.

Norepinephrine

Catecholamine with strong alpha-adrenergic effects and mild beta effects; increases blood pressure and afterload; used in severe hypotension.

CPAP (continuous positive airway pressure)

Mask-based therapy that improves oxygenation, reduces work of breathing, and can reverse pulmonary edema, potentially avoiding intubation.

Oxygen therapy

Supplemental O2 to treat hypoxemia and decrease myocardial work; effectiveness may be limited by capillary shunting in edema.

Orthopnea

Dyspnea that worsens when lying flat or recumbent due to redistribution of fluids and increased venous return.

Paroxysmal nocturnal dyspnea (PND)

Sudden nighttime episodes of severe dyspnea common in cardiogenic edema when recumbent and venous return increases.

Left ventricular ejection fraction (LVEF)

Percentage of blood ejected from the left ventricle with each beat; noninvasive measure of contractility; normal typically >50%.

Abnormal lab finding: hypokalemia, hyponatremia, hypochloremia

Common electrolyte abnormalities in left-sided heart failure and during diuretic therapy, reflecting diuresis and fluid shifts.

Bere radiologic signs of pulmonary edema

Central vascular congestion, Kerley lines, bat-wing pattern, and possible pleural effusions seen on chest radiographs.