Introduction to acute cardiogenic pulmonary oedema
Acute cardiogenic pulmonary oedema is a medical emergency. Differentiation from other causes of acute breathlessness (eg acute or chronic obstructive pulmonary disease, pulmonary embolus, asthma, pneumonia) can often be difficult, and these conditions can coexist.
Acute cardiogenic pulmonary oedema presents as rapid onset of severe dyspnoea (often first occurring at night) as well as tachypnoea and tachycardia. Other features may include poor peripheral perfusion (ashen colour, sweaty, cool peripheries and reduced capillary return), agitation and restlessness, and widespread lung crackles (although occasionally only wheezing may be detected). Exhaustion and altered conscious state will follow if untreated. The clinical features stem from the 2 major pathophysiological processes: intra-alveolar fluid accumulation and extreme sympathetic nervous system activation.
Educate patients with chronic heart failure on how to recognise the earliest manifestations of pulmonary oedema (increasing breathlessness, nocturnal dyspnoea and cough). An action plan helps the patient to respond to these symptoms early1. An acute exacerbation may be prevented by reducing fluid intake, increasing furosemide (frusemide) dosage and modifying other drugs.