Chapter 15: Acute Pulmonary Edema

Chapter 15: Acute Pulmonary Edema is a topic covered in the Harrison's Manual of Medicine.

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Life-threatening, acute development of alveolar lung edema due to one or more of the following:

  1. Elevation of hydrostatic pressure in the pulmonary capillaries (left heart failure, mitral valve disease).
  2. Specific precipitants (Table 15-1), resulting in cardiogenic pulmonary edema in pts with previously compensated heart failure or without previous cardiac history.
  3. Increased permeability of pulmonary alveolar-capillary membrane (noncardiogenic pulmonary edema). For common causes, see Table 15-2.
TABLE 15-1: Precipitants of Acute Pulmonary Edema
Acute tachy- or bradyarrhythmia
Infection, fever
Acute MI
Severe hypertension
Acute mitral or aortic regurgitation
Increased circulating volume (Na+ ingestion, blood transfusion, pregnancy)
Increased metabolic demands (exercise, hyperthyroidism)
Pulmonary embolism
Noncompliance (sudden discontinuation) of chronic heart failure medications
TABLE 15-2: Common Causes of Noncardiogenic Pulmonary Edema
Direct Injury to Lung
Chest trauma, pulmonary contusionPneumonia
AspirationOxygen toxicity
Smoke inhalationPulmonary embolism, reperfusion
Hematogenous Injury to Lung
SepsisMultiple transfusions
PancreatitisIV drug use, e.g., heroin
Nonthoracic traumaCardiopulmonary bypass
Possible Lung Injury Plus Elevated Hydrostatic Pressures
High-altitude pulmonary edemaReexpansion pulmonary edema
Neurogenic pulmonary edema 

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Life-threatening, acute development of alveolar lung edema due to one or more of the following:

  1. Elevation of hydrostatic pressure in the pulmonary capillaries (left heart failure, mitral valve disease).
  2. Specific precipitants (Table 15-1), resulting in cardiogenic pulmonary edema in pts with previously compensated heart failure or without previous cardiac history.
  3. Increased permeability of pulmonary alveolar-capillary membrane (noncardiogenic pulmonary edema). For common causes, see Table 15-2.
TABLE 15-1: Precipitants of Acute Pulmonary Edema
Acute tachy- or bradyarrhythmia
Infection, fever
Acute MI
Severe hypertension
Acute mitral or aortic regurgitation
Increased circulating volume (Na+ ingestion, blood transfusion, pregnancy)
Increased metabolic demands (exercise, hyperthyroidism)
Pulmonary embolism
Noncompliance (sudden discontinuation) of chronic heart failure medications
TABLE 15-2: Common Causes of Noncardiogenic Pulmonary Edema
Direct Injury to Lung
Chest trauma, pulmonary contusionPneumonia
AspirationOxygen toxicity
Smoke inhalationPulmonary embolism, reperfusion
Hematogenous Injury to Lung
SepsisMultiple transfusions
PancreatitisIV drug use, e.g., heroin
Nonthoracic traumaCardiopulmonary bypass
Possible Lung Injury Plus Elevated Hydrostatic Pressures
High-altitude pulmonary edemaReexpansion pulmonary edema
Neurogenic pulmonary edema 

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