Context and Definition

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).

Figure 1: Clinical Presentations of Acute Heart Failure

The European Society of Cardiologys (ESC) 2016 Guidelines on heart failure defined heart failure as patients with 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

The 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)