Cardiogenic Pulmonary Oedema

Author: Victoria L Henson / Editor: Jason M Kendall / Reviewer: Louise Burrows, Peter Kilgour, Debkumar Chowdhury / Codes: / Published: 22/03/2021 / Reviewed: 30/05/2025

This module discusses cardiogenic pulmonary oedema, covering its causes, clinical assessment, management and long-term outcomes. It guides Emergency Medicine (EM) clinicians in assessing breathless patients and outlines appropriate investigations and treatments.

After completing this session you will be able to:

• Define cardiogenic pulmonary oedema
• Describe the pathophysiology of cardiogenic pulmonary oedema
• Clinically assess a breathless patient and recognise cardiogenic pulmonary oedema
• Investigate and treat cardiogenic pulmonary oedema within the emergency department (ED)
• Describe the long-term outcome for this patient group

References

1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: : Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. Erratum in: Eur Heart J. 2021 Dec 21;42(48):4901.
2. Chaudhry MM. et al. Correlation between Elevated D-Dimer and BNP Levels in Various Clinical Diagnoses. Journal of Cardiac Failure, Volume 15, Issue 6, S35, 2009.
3. Rippey J. Lung ultrasound: Pulmonary oedema. Life in the Fast Lane, 2022.
4. McDonagh TA, Metra M, Adamo M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-3639. doi: 10.1093/eurheartj/ehad195. Erratum in: Eur Heart J. 2024 Jan 1;45(1):53.
5. A Gray, et al. Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema. The New England Journal of Medicine. July 10 2008. Vol 359, iss 2: pg 142.
6. O’Driscoll BR, Howard LS, Earis J on behalf of the BTS Emergency Oxygen Guideline Development Group, et al. British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings. BMJ Open Respiratory Research 2017;4:e000170.
7. Vital FM, Saconato H, Ladeira MT, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005351. doi: 10.1002/14651858.CD005351.pub2. Update in: Cochrane Database Syst Rev. 2013 May 31;(5):CD005351.
8. Mattu A, Martinez JP, Kelly BS. Modern management of cardiogenic pulmonary edema. Emerg Med Clin North Am. 2005 Nov;23(4):1105-25.
9. Feldman D, Menachemi DM, Abraham WT, Wexler RK. Management strategies for stage-D patients with acute heart failure. Clin Cardiol. 2008 Jul;31(7):297-301.
10. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998 Feb 7;351(9100):389-93.
11. Metra M, Teerlink JR, Voors AA, et al. Vasodilators in the treatment of acute heart failure: what we know, what we don’t. Heart Fail Rev. 2009 Dec;14(4):299-307.