Cardiogenic pulmonary oedema (CPO) is a common presentation to the Emergency Department (ED).
There are 3 key issues in the management of CPO:
- correct and early identification of the condition
- prompt instigation of appropriate treatment
- detection of the underlying cause.
Patients who present with CPO have a poor long term outcome but their short term mortality can be improved by early correct management.
There is no formal definition of CPO; however it is characterised by the presence of excess fluid within the pulmonary interstitium and, at its most severe, within the alveoli. CPO is pulmonary oedema due to a primary cardiac or circulatory cause rather than other forms of pulmonary oedema (eg. neurogenic pulmonary oedema). CPO may be a feature of several different types of acute heart failure presentation (see Figure 1).
The European Society of Cardiology (ESC) Guidelines defined acute heart failure as: A rapid onset or change in signs or symptoms of heart failure, resulting in the need for urgent therapy . Patients may present as a medical emergency such as acute pulmonary oedema. [1] Patients with may experience all of the following [1]:
- Symptoms typical of heart failure
- Signs of heart failure
- Objective evidence of structural or functional abnormality of the heart at rest
According to the 2021 ESC guidelines [1]:
- Reduced LVEF- </=40%- HFrEF (Heart failure with reduced EF)
- LVEF between 41%-49%-HFmEF (Heart failure with mildly reduced EF)
- Signs and symptoms of HF with evidence of structural or functional cardiac dysfunction and/or raised natriuretic peptides and LVEF>/50%- HFpEF (Heart failure with preserved EF)