Acute edema of the lung

The acute edema of the lung is a secondary lung disease with the flood or the brutal accumulation of liquids on the level of the Poumon S (cells or pulmonary interstitial spaces). This state will be responsible for disorders of the gaseous exchange and can involve a respiratory insufficiency.

Most frequently, it is of origin cardiac and due to a acute Cardiac failure left (one speaks about edema cardiogenic). It can also be related to lesions of the pulmonary parenchyma (one speaks about organic edema).

This article treats pulmonary acute edema cardiogenic (of cardiac origin). The mechanisms and the assumption of responsibility of the organic pulmonary edema is treated in the article Syndrome of acute respiratory distress.

Epidemiology

August 1st

Causes

The pulmonary edema can be related to a faulty operation of the Cœur or circulatory system (edema cardiogenic) or on lesions of the pulmonary fabrics (edema noncardiogenic or organic).

Edema of cardiogenic origin

All cardiac pathologies can have as a complication a pulmonary edema. It is advisable in all the cases to seek a factor supporting the decompensation of the cardiopathy.

Pathologies in causes are:

  • the ischemic cardiopathies (47% of the cases),
  • the hypertensives cardiopathies,
  • the cardiac valvulopathies: mitral Contracting, aortic Contracting, aortic Insufficiency during a Endocarditis and mitral Insufficiency by rupture of rope or bacterial endocarditis, in the event of dysfunction of a valvular prosthesis,
  • a disorder of the cardiac rhythm,
  • the Cardiomyopathie S,
  • some congenital cardiopathies.

Organic edema of origin (noncardiogenic)

The noncardiac causes are generally in relation to a acute respiratory distress.

A pulmonary edema can occur in the event of pollutant gas inhalation, of blood Transfusion massive, of a pulmonary contusion, within the framework of a Polytraumatisme, in the event of Noyade, of inhalation of gastric liquid (Syndrome of Mendelson), in the event of obstruction of the higher air routes, rise with high-altitude (pulmonary edema of high-altitude).

Physiopathology

Normally, the quantity of liquid in pulmonary interstitium is related to balance between the passage of liquid through the pulmonary capillary endothelium towards interstitial spaces and its elimination by the lymphatic system. The physiopathology of the oedemas rises from an imbalance in the equation of Starling (see article " Edema ").

The cardiac attacks are likely to involve a rise in the pressures of filling of the left heart (left ventricular telediastolic pressure), thus involving an increase in the pulmonary capillary pressure. The pressure known as hydrostatic increasing, there is passage of liquid since the pulmonary capillary blood compartment towards the interstitial sector and the air cells: it is the pulmonary edema. This extravasation of liquid in the lungs is at the origin of a respiratory distress: it is a therapeutic urgency.

The pulmonary edema can also have due to the lesions of the pulmonary parenchyma, responsible for an increase in the permeability of the membrane alvéolo-capillary.

A particular cause: the " foramen oval perméable". The presence of a permeable foramen oval (consistent with the possibility of passage of blood between the two Auricle S through an imperfectly tight wall) is four times more frequent at the subjects presenting a pulmonary edema of high-altitude characterized by a pulmonary arterial Hypertension and a Hypoxémie of altitude.

Diagnosis

Functional signs

The subject presents a Dyspnée, i.e. a distressing respiratory embarrassment (fast or progressive installation), a Orthopnée (breathing difficulty in position lying). It can also exist a Toux night, a Expectoration (dew, blanchâtre, sparkling), one grésillement laryngé.
Une " crisis of asthme" occurring with more than 65 years corresponds in the majority of the cases to a pulmonary edema.

The subject can also present signs in connection with pathology responsible for the pulmonary edema: a thoracic Pain, a Fever…

Clinical examination

The examination can highlight a Cyanose, a increase in the blood pressure (except state of shock).
L' cardiopulmonary ausculation highlights a Tachycardie (a Bradycardie being a sign of gravity), inconstant left gallop, rails crépitants, rails sibilants. One seeks a Heart murmur systematically in the search of a valvulopathy.

Complementary examinations

A biological assessment is systematically carried out with in addition to a standard assessment, a proportioning of the cardiac enzymes; the remainder of the assessment carried out depend on the context and the suspectée etiology. A proportioning of BNP can be useful in case of doubt about the cardiac origin of the Dyspnée.
Un arterial taking away for the realization of an arterial gazometry " Gas of blood " , a Hypoxie, Hypocapnie highlights (a Hypercapnie being a sign of gravity), a Metabolic acidosis.

A Radiographie pulmonary standard will make it possible to seek:

  • a cardiomégalie, i.e. an increase in size of the cardiac sihouette (its absence is possible),
  • a interstitial Syndrome,
  • of the lines of Kerley B,
  • sometimes a épanchement pleural,
  • of opacities alveolar, flocculent, generally bilateral and symmetrical, often systematized para-hilaires in " wings of papillon" , sometimes diffuse (but can be unilateral and asymmetrical).

A electrocardiogram will be systematically carried out in the search of turbid of the rate/rhythm or the conduction, of the signs of myocardic ischaemia, a left ventricular hypertrophy.

A cardiac echography will make it possible to study the function of the left ventricle, the subjacent cardiopathy, will possibly make it possible to find a starting factor.

Signs of gravity

They are to be sought systematically and can be clinical or biological:

Assumption of responsibility

The patient must be placed in position semi-base, legs hanging if possible.
Le treatment includes/understands:

  • a oxygen treatment for a saturation in Oxygen (SaO2) higher than 90% (to be adapted to the Gas of blood),
  • the use of venous vasodilators (nitrated derivatives), of diuretic of the handle,
  • a treatment Anticoagulant (with preventive or curative amount according to the case).

The treatment of the cause and the correction of the starting factors are essential to the catch den load.

Random links:Dwight David Eisenhower | Reichsmarine | Fountain (Territory of Belfort) | Biliary pigment | Quintet with clarinet of Mozart | Richard von Kühlmann | Enfant_de_fée