Fluid then transudates into the interstitium and the alveoli once this leak exceeds the lymphatics ability to reabsorb fluid the accumulating fluid hinders gas exchange and hypoxia develops. This causes the normally low pressure system of the pulmonary vasculature to increase resulting in hydrostatic pressure exceeding oncotic pressure. If the left ventricle is unable to empty the blood that it receives from the lungs, there is a consequent rise in the end diastolic volume and pressure. Patients may present as a medical emergency such as acute pulmonary oedema.(1) PathophysiologyĬPO arises due to a combination of problems arising within the circulatory system which have a knock on effect on one another causing a spiralling cycle of increasing fluid accumulation within the lungs which hinders gas exchange leading to worsening hypoxia and respiratory failure (see Figure 2). The ESC Guidelines defined acute heart failure as:Ī rapid onset or change in signs or symptoms of heart failure, resulting in the need for urgent therapy. Objective evidence of structural or functional abnormality of the heart at rest.
The European Society of Cardiologys (ESC) 2016 Guidelines on heart failure defined heart failure as patients with all of the following(1): CPO may be a feature of several different types of acute heart failure presentation (see Figure 1).įigure 1: Clinical Presentations of Acute Heart Failure CPO is pulmonary oedema due to a primary cardiac or circulatory cause rather than other forms of pulmonary oedema (eg. 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.
Patients who present with CPO have a poor long term outcome but their short term mortality can be improved by early correct management. prompt instigation of appropriate treatment.correct and early identification of the condition.There are 3 key issues in the management of CPO: Cardiogenic pulmonary oedema (CPO) is a common presentation to the Emergency Department (ED).