TAILIEUCHUNG - 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. | 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 . 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

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