Pulmonary edema is a form of acute insufficiency
Acute congestive heart failure. Pulmonary edema.
Acute congestive heart failure - sudden violation of the pumping function of the heart, leading to the inability to provide adequate blood circulation, despite the inclusion of compensatory mechanisms.
Etiology of acute heart failure
Acute congestive heart failure often develops due to diseases,leading to a rapid and significant reduction in cardiac output (most often with myocardial infarction). However, acute heart failure is also possible with a high cardiac output. The main causes of acute heart failure are listed in the table.
Acute congestive heart failure has three clinical manifestations: cardiac asthma, pulmonary edema and cardiogenic shock. In each specific case, it is recommended to indicate the form of acute heart failure (cardiac asthma, cardiogenic shock or pulmonary edema), and not the general term "acute heart failure".
Suffocation (cardiac asthma, paroxysmal nocturnal dyspnea)occurs in left ventricular heart failure as a result of blood stagnation in a small circle of blood circulation when the patient is lying down as a manifestation of interstitial edema of the lungs and a sharp increase in blood pressure in the vessels of the small circulation.
The main causes of acute heart failure
Pulmonary edema subdivided into interstitial (observed with cardiac asthma) and alveolar, which must be considered as two stages of a single process.
• Interstitial pulmonary edema - Edema of the parenchyma of the lungs without the release of the transudate into the lumen of the alveoli. Clinically manifested as shortness of breath and cough without phlegm. When the process progresses, alveolar edema occurs.
• Alveolar edema of the lungs is characterized by the swelling of plasma in the lumen of the alveoli. Patients have a cough with a separation of foamy sputum, suffocation, in the lungs first dry and then wet rales are heard.
Pulmonary edema develops with an increase in the wedging pressure of the pulmonary capillaries more than 25 mm Hg.
• Basic links pathogenesis of interstitial pulmonary edema. increased pressure in the lumen of the pulmonary capillaries, increased lymph flow, increased extravascular fluid volume, increased resistance of small bronchial tubes, reduced stretchability of the lung tissue.
• Long-term increase in intravascularpressure leads to a violation of the integrity of the alveolar-capillary membrane and the exit into the cavity of the alveoli of fluid, macromolecules and erythrocytes. In the future, hypoxia, hypercapnia and acidosis, leading to respiratory arrest, occur.
Treatment and prognosis of pulmonary edema
When swelling of the lungs, emergency measures are necessary, since the mortality rate is 15-20%.
Cardiogenic shock develops as a result of a sudden declinecardiac output. As a rule, it occurs with extensive myocardial infarction against the background of multiple lesions of the coronary arteries. Details cardiogenic shock is described in the article "Cardiogenic shock".