Pulmonary Edema: Pathophysiology, Symptoms, and Urgency

Pulmonary edema is the accumulation of fluid in the alveoli and lung interstitium due to elevated pulmonary capillary pressure (cardiogenic) or increased capillary permeability (non-cardiogenic).

Cardiogenic Pulmonary Edema (Most Common)

Left heart failure → ↑ left atrial pressure → ↑ pulmonary venous pressure → ↑ capillary hydrostatic pressure → fluid transudation into alveoli.

Clinical Presentation

• Acute dyspnea, orthopnea, paroxysmal nocturnal dyspnea
• Cough with pink, frothy sputum
• Tachycardia, hypertension (initially), then hypotension if cardiogenic shock
• Crackles on auscultation, hypoxemia

Management

• Sit upright, high-flow oxygen, non-invasive ventilation (CPAP/BiPAP)
• IV loop diuretics (furosemide)
• Vasodilators (nitroglycerin) if BP permits
• Treat underlying cause (ACS, arrhythmia, volume overload)

Pulmonary edema is a medical emergency requiring immediate intervention.