Cardiac failure and pulmonary oedema

26 Cardiac failure and pulmonary oedema



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Fig. 26.1A Pulmonary oedema due to heart failure. Mild.



Background


The commonest causes of pulmonary oedema encountered by the on-call doctor are cardiac failure and iatrogenic fluid overload. The latter should be clear within its clinical context. Cardiogenic pulmonary oedema coexists with cardiac enlargement. See the section on PA versus AP projection, Chapter 6, page 37.



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Fig. 26.1B Pulmonary oedema due to heart failure. Moderate.


Pulmonary oedema can develop quickly (e.g. associated with myocardial infarct, renal failure/artery stenosis) or more slowly (gradual fluid overload due to cardiac failure).



Clinical features



Symptoms


Symptoms include dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema.


The clinical context is important: Is the patient on fluids following surgery? Is there a known history of cardiac or renal failure, or of fever or drowning?



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Fig. 26.1C Pulmonary oedema due to heart failure. Severe.



Signs


The main signs are fine basal crackles, raised JVP, added heart sounds, murmurs (cause or effect), displaced apex beat and peripheral oedema.


These patients can present to almost any on-call doctor – medical admission or wards, postoperative patients given too much fluid, and the ED.



Differential diagnosis


Any cause of fluid in the alveoli can give the appearance of ‘airspace shadowing’ on the CXR. This causes areas of soft tissue density (grey-white) on the background air density (black).


The lung changes seen in cardiac failure are generally bilateral and symmetrical in distribution, but may be asymmetrical with right-sided changes predominating. There are also several other radiological clues described below.


Other types of fluid in the alveoli can cause unilateral or bilateral but often asymmetric airspace shadowing, for example pus in pneumonia (Chapter 8) blood in contusion and bronchioloalveolar carcinoma.


It is important to correlate these findings with the patient’s clinical features in order to make the correct diagnosis.


Remember as well that pneumonia and heart failure may coexist and serial CXRs may be necessary for diagnosis. Pulmonary oedema is more fleeting than consolidation radiographically and with treatment will resolve quickly. Even with treatment, the radiographic changes of pneumonia will persist for longer.

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Cardiac failure and pulmonary oedema

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