Pulmonary Oedema

Left ventricular failure associated with pulmonary oedema presents with increasing breathlessness, reduced arterial oxygen saturations, tachycardia, a third heart sound and pulmonary crepitations. Clinical examination should be directed to exclude other complications as causes of heart failure (arrythmias and valvular abnormalities). Chest x-ray will confirm pulmonary congestion, and echocardiography may quantify mechanical left ventricular function (ventricular wall akinesis, reduced ejection fraction, etc.).

Treatment consists of measures to treat the underlying STEMI (i.e. reperfusion) and specific therapies for left ventricular failure and pulmonary oedema: diuretics, intravenous nitrates, non-invasive ventilatory support, ACE inhibitors and, where appropriate, tracheal intubation.

Learning Bite

Pulmonary oedema, like many of the early complications of STEMI, is treated by effective reperfusion.