Congestive Heart Failure and Pulmonary Edema

Yes, congestive heart failure (CHF) is a direct cause of pulmonary edema, particularly in its acute decompensated form. 1

Pathophysiology of Pulmonary Edema in CHF

Pulmonary edema develops when increased left ventricular filling pressures lead to elevated pulmonary venous pressure, causing fluid to shift from the intravascular compartment into the pulmonary interstitium and alveoli 2
In CHF, cardiac dysfunction results in inadequate forward flow and increased backward pressure, leading to pulmonary congestion 1
The rate of fluid transudation into the lung interstitium exceeds the capacity of pulmonary lymphatics to drain away the fluid, resulting in accumulation of fluid in the lungs 3
Acute cardiogenic pulmonary edema is one of the main forms of presentation of acute heart failure with high mortality requiring prompt management 4

Acute pulmonary edema presents with severe respiratory distress, tachypnea, orthopnea, and rales over the lung fields 1
Arterial oxygen saturation is typically less than 90% on room air prior to treatment with oxygen 1
Major clinical signs include orthopnea, jugular venous distension, hepatojugular reflux, rales, S3 gallop rhythm, and cardiomegaly 1
Patients may present with a spectrum of symptoms ranging from acute pulmonary edema to gross fluid retention with peripheral edema 3

Both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) can cause pulmonary edema 1
Hypertensive heart failure often presents with pulmonary congestion without significant peripheral edema 1
Decompensated chronic heart failure frequently manifests with pulmonary edema 1
Right heart failure can eventually lead to pulmonary congestion when the condition progresses to biventricular failure 1

Intravenous furosemide is specifically indicated for acute pulmonary edema as adjunctive therapy 5
Vasodilators like nitroglycerin (starting dose 0.3-0.5 μg/kg/min IV) are effective first-line treatments for reducing preload and improving symptoms 1, 6
Sodium nitroprusside (starting dose 0.1 μg/kg/min) may be selected for patients not immediately responsive to nitrate therapy, especially in cases with severe valvular regurgitation or marked hypertension 1
Non-invasive positive pressure ventilation is an effective adjunct to pharmacological treatment 6
In cases of cardiogenic shock with pulmonary edema, inotropic support may be necessary 4

Patients with heart failure should be instructed to monitor for weight gain and the presence of pedal edema 1
Symptoms suggestive of developing pulmonary edema include orthopnea, paroxysmal nocturnal dyspnea, unexplained cough or fatigue 1
Physical examination should assess for signs of heart failure such as jugular venous distention, S3 gallop, and pulmonary rales 1
Brain natriuretic peptide measurement can be helpful in diagnosing pulmonary congestion 1
Echocardiography is essential to assess cardiac function and identify structural abnormalities contributing to pulmonary edema 1