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Table 47.1

Causes of Acute Pulmonary Oedema

Causes due to elevated pressure in the pulmonary capillaries

Cardiac disease, new presentation:

  • Acute myocardial infarction or severe myocardial ischaemia
  • Acute myocarditis
  • Severe aortic or mitral stenosis
  • Acute aortic regurgitation (aortic dissection, infective endocarditis, chest trauma)
  • Acute mitral regurgitation (infective endocarditis, ruptured chordae or papillary muscle, chest trauma)
  • Ventricular septal rupture after myocardial infarction
  • Left atrial myxoma
Precipitants of pulmonary oedema in patients with previously stable valve or left ventricular disease:
  • Acute myocardial infarction or myocardial ischaemia
  • Arrhythmia
  • Poor compliance with diuretic therapy
  • Drugs causing fluid retention (e.g. NSAIDs, steroids)
  • Iatrogenic fluid overload
  • Infective endocarditis
  • Progression of disease
  • Intercurrent illness (e.g. pneumonia, anaemia)
Renal disease:

Iatrogenic fluid overload

Subarachnoid haemorrhage

Negative-pressure pulmonary oedema (Table 47.8)

Causes due to increased pulmonary capillary permeability(acute lung injury/ARDS); for management see Table 47.7
Direct lung injuryIndirect lung injury
Common causes
Pneumonia (viral or bacterial)Sepsis
Aspiration of gastric contentsSevere trauma with shock and multiple transfusions
Less common causes
Pulmonary contusionCardiopulmonary by-pass
Fat emboliDrug overdose
DrowningAcute pancreatitis
Inhalational injuryTransfusions of blood
Reperfusion pulmonary oedema after lung transplantation or pulmonary embolectomyproducts

ARDS, acute respiratory distress syndrome; NSAIDs, non-steroidal anti- inflammatory drugs.