Treatment of acute pulmonary edema (cardiac asthma)

Acute pulmonary edema (APE) is one of the acute complications of left-sided HF.

Management:

• Hospitalization.

• Semi-setting or sitting position.

• Oxygen: reduce pulmonary capillary pressure and edema.

• Morphine: (5 mg i.v.) because: Analgesic effect → ↓ stress of the patient. Venodilatation → ↓ VR → ↓ lung congestion. It ↓ pulmonary stretch reflex → ↓ tachypnea → ↓ exhaustion of the patient.

• Diuretics: (furosemide 40 mg i.v.) because: It ↓ pulmonary wedge pressure → ↓ pulmonary edema. Diuretic effect and ↓ ECF volume (preload). It ↓ systemic BP (afterload).

• Rapid digitalization (0.25 mg i.v.): provided that there are no contraindications.

• Aminophylline: (250 mg slowly i.v.) because: It causes bronchodilatation. It ↑ myocardial contractility. It ↑ RBF → diuretic effect.

• Treatment of the precipitating factor: e.g. hypertension Use…..  Vasodilators as nifedipine or captopril sublingual…………………..