cardiovascular disorders
Pulmonary Edema
Treatment of Pulmonary Edema
Treatment of cause Oxygen IV diuretic Nitrates IV inotropes Ventilatory assistance , 1 to 5 mg IV once or twice, has long been used to reduce severe anxiety and the work of breathing but is decreasingly used (except in palliative care) due to observational studies suggesting a poorer outcome with its use. Noninvasive ventilatory assistance with bilevel positive airway pressure (BiPAP) is helpful if hypoxia is significant. If carbon dioxide retention is present or the patient is obtunded, Tracheal Intubation and Specific additional treatment depends on etiology: For acute myocardial infarction or another acute coronary syndrome, thrombolysis or direct percutaneous coronary angioplasty with or without stent placement For severe hypertension, an IV vasodilator For supraventricular or ventricular tachycardia, direct-current cardioversion For rapid atrial fibrillation, cardioversion is preferred. To slow the ventricular rate, an IV beta-blocker, IVdigoxin, or cautious use of an IV calcium channel blocker In patients with acute MI (myocardial infarction), fluid status before onset of pulmonary edema is usually normal, so diuretics are less useful than in patients with acute decompensation of chronic heart failure and may precipitate hypotension. If systolic blood pressure falls<100 mm Hg or shock develops, IVdobutamineand an intra-aortic balloon pump (counterpulsation) may be required. ), and calcium-sensitizing inotropic drugs (levosimendan, pimobendan), vesnarinone, and ibopamine, may have initial beneficial effects but do not appear to improve outcomes compared to standard therapy, and mortality may be increased. Serelaxin, a recombinant form of the human pregnancy hormone relaxin-2, has been tried but benefits were not shown in a large international randomized study ( Treatment references ). Omecamtiv mecarbil, an oral cardiac myosin activator, has been shown to reduce morbidity and mortality in patients currently or recently hospitalized with decompensated heart failure ( Once patients are stabilized, long-term Treatment is begun. 1.Metra M, Teerlink JR, Cotter G, et al: Effects ofserelaxinin patients with acute heart failure.N Engl J Med381(8):716-726, 2019. doi:10.1056/NEJMoa1801291 2.Teerlink JR, Diaz R, Felker GM, et al: Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure.N Engl J Med384(2):105-116, 2021. doi:10.1056/NEJMoa2025797 