Chapter 033. Dyspnea and Pulmonary Edema (Part 6) pps

Dyspnea and Pulmonary Edema Part 6 Distinguishing Cardiogenic from Noncardiogenic Pulmonary Edema The history is essential for assessing the likelihood of underlying cardiac disease

Chapter 033 Dyspnea and Pulmonary Edema

(Part 6)

Distinguishing Cardiogenic from Noncardiogenic Pulmonary Edema

The history is essential for assessing the likelihood of underlying cardiac

disease as well as for identification of one of the conditions associated with noncardiogenic pulmonary edema

The physical examination in cardiogenic pulmonary edema is notable for

evidence of increased intracardiac pressures (S3 gallop, elevated jugular venous pulse, peripheral edema), and rales and/or wheezes on auscultation of the chest

In contrast, the physical examination in noncardiogenic pulmonary edema

is dominated by the findings of the precipitating condition; pulmonary findings may be relatively normal in the early stages

The chest radiograph in cardiogenic pulmonary edema typically shows an

enlarged cardiac silhouette, vascular redistribution, interstitial thickening, and perihilar alveolar infiltrates; pleural effusions are common

In noncardiogenic pulmonary edema, heart size is normal, alveolar infiltrates are distributed more uniformly throughout the lungs, and pleural effusions are uncommon

Finally, the hypoxemia of cardiogenic pulmonary edema is due largely to

ventilation-perfusion mismatch and responds to the administration of supplemental oxygen

In contrast, hypoxemia in noncardiogenic pulmonary edema is due primarily to intrapulmonary shunting and typically persists despite high concentrations of inhaled O2

Further Readings

Abidov A et al: Prognostic significance of dyspnea in patients referred for cardiac stress testing N Engl J Med 353:1889, 2005 [PMID: 16267320]

Dyspnea mechanisms, assessment, and management: A consensus statement Am Rev Resp Crit Care Med 159:321, 1999

Gillette MA, Schwartzstein RM: Mechanisms of dyspnea, in Supportive

Care in Respiratory Disease, SH Ahmedzai and MF Muer (eds) Oxford, U.K.,

Oxford University Press, 2005

Mahler DA et al Descriptors of breathlessness in cardiorespiratory diseases Am J Respir Crit Care Med 154:1357, 1996 [PMID: 8912748]

———, O'Donnell DE (eds): Dyspnea: Mechanisms, Measurement, and

Management New York, Marcel Dekker, 2005

Schwartzstein RM The language of dyspnea, in Dyspnea: Mechanisms,

Measurement, and Management, DA Mahler and DE O'Donnell (eds) New York,

Marcel Dekker, 2005

———, Feller-Kopman D Shortness of breath, in Primary Care

Cardiology, 2d ed, E Braunwald and L Goldman (eds) Philadelphia: WB

Saunders, 2003