Describe the flash pulmonary edema.
Sudden-onset, potentially life-threatening cardiogenic pulmonary edema that can cause acute hypoxemic respiratory failure
Can occur in de novo heart failure and acute decompensated heart failure (ADHF)
List risk factors.
Long-standing poorly controlled hypertension [8]
LVH and diastolic dysfunction
Bilateral renal artery stenosis [10]
Coronary artery disease
Obstructive sleep apnea
List triggers.
similar to those of ADHF [9]
Sympathetic activation
Abrupt hemodynamic changes
Describe the pathophysiology.
Multiple processes lead to a vicious cycle of sympathetically-driven ↑ LVEDP and pulmonary edema. [8][9]
Long-term hypertension → ↑ atherosclerosis and cardiac remodeling → ↑ afterload and ↑ MVO2, LVH, and ↑ diastolic dysfunction
Sympathetic activation → peripheral and splanchnic vasoconstriction→ ↑ venous return and ↑ afterload → ↑ pulmonary edema and ↓ cardiac output
↑ Pulmonary edema and ↓ cardiac output → end-organ dysfunction and hypoxemia → ↑ sympathetic activation
List clinical features.
Hypertension, hypoxia
Features of pulmonary congestion: e.g., crackles, signs of increased work of breathing, respiratory distress signs
Minimal peripheral edema
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