From the Research
In the UK, patients with pulmonary edema should undergo echocardiography urgently, ideally within 24 hours of presentation if the patient is hemodynamically unstable or within 48 hours for stable patients, as recommended by recent guidelines and studies 1. The urgency of echocardiography is determined by clinical severity, with patients in acute heart failure requiring more immediate imaging. This timing recommendation reflects the need to identify the underlying cardiac cause of pulmonary edema, which may include left ventricular systolic dysfunction, valvular heart disease, or diastolic dysfunction. Some key points to consider when evaluating patients with pulmonary edema include:
- The importance of early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation, as noted in a review of cardiogenic pulmonary edema 2
- The need for prompt echocardiography to guide management decisions, including medication adjustments, need for mechanical ventilation, or consideration of interventional procedures, as highlighted in a study on the diagnosis and management of cardiogenic pulmonary edema 3
- The potential benefits of non-invasive ventilation, diuretics, and vasodilators in the treatment of cardiogenic pulmonary edema, as discussed in a recent review of the pathophysiology, clinical presentation, and management of cardiogenic pulmonary edema 1 Delays in obtaining echocardiography may lead to suboptimal treatment and potentially worse outcomes, particularly in cases where the pulmonary edema is due to a mechanical problem like severe mitral regurgitation or ventricular septal rupture that may require urgent surgical intervention. The most recent and highest quality study, published in 2023, supports the importance of urgent echocardiography in patients with pulmonary edema, and provides guidance on the management of cardiogenic pulmonary edema, including the use of non-invasive ventilation, diuretics, and vasodilators 1.