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| __NOTOC__
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| {{Pulmonary edema}}
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| {{CMG}}
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| ==Medical Therapy==
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| ===Acute Pulmonary Edema===
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| In patients with acute pulmonary edema, the goal is to reduce both [[preload]] and [[afterload]] and to [[diurese]] the patient. Intravenous nitroglycerin can be used to reduce both the preload and afterload. Diuretics such as [[furosemide]] or [[bumetanide]] can be used to reduce volume overload. The dose that the patient is on chronically should be doubled and administered intravenously in the setting of flash pulmonary edema. [[Morphine sulfate]] may be helpful in reducing the drive to breathe, improving patient comfort, and reducing the [[preload]].
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| Oxygen therapy is required to minimize [[cyanosis]] and to maintain adequate oxygenation. High-flow oxygen, noninvasive ventilation (either [[continuous positive airway pressure]] (CPAP) or variable positive airway pressure (VPAP) may be effective<ref>Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. ''JAMA'' 2005;294:3124-30. PMID 16380593.</ref><ref>Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. ''Lancet'' 2006;367(9517):1155-63. PMID 16616558.</ref>). If the simple measures are not effective then [[mechanical ventilation]] may be required.
| | #redirect:[[Congestive heart failure acute pharmacotherapy]] |
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| Treatment should also be directed at managing the underlying cause of an episode of acute pulmonary edema. This would include managing as [[acute myocardial infarction]], [[mitral regurgitation]], [[aortic regurgitation]], or any other condition that causes an increase in left ventricular filling pressures.
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| ===Chronic Pulmonary Edema===
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| Reoccurrence of FPE is thought to be associated with [[hypertension]]<ref>Kramer K, Kirkman P, Kitzman D, Little WC. Flash pulmonary edema: association with hypertension and reoccurrence despite coronary revascularization. Am Heart J. 2000 Sep;140(3):451-5. PMID 10966547.</ref> and may signify [[renal artery stenosis]].<ref>Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH. Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation. ''Lancet'' 1988;2(8610):551-2. PMID 2900930.</ref> Prevention of reoccurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Pulmonology]]
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| [[Category:Emergency medicine]]
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| [[Category:Mountaineering]]
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| [[Category:Cardiology]]
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| [[Category:Disease]]
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| [[Category:Needs overview]]
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