Flash pulmonary edema: association with hypertension and reoccurrence despite coronary revascularization

The sudden development of acute (flash) pulmonary edema may be an indication for coronary angiography and revascularization. However, the prevalence of coronary artery disease in these patients and the outcome after revascularization are not known.

We evaluated 46 patients with an initial presentation of flash pulmonary edema requiring hospitalization and obtained up to 3 years of follow-up in 45 patients. There were 22 men and 24 women, 44 to 84 years of age (67 +/- 10 years, mean +/- SD). Systolic blood pressure on admission was 194 +/- 38 mm Hg. Twenty-four patients required intubation and mechanical ventilation. Left ventricular ejection fraction was >40% in 27 of 46 patients. Thirty-eight patients underwent coronary angiography; 33 had obstructive coronary artery disease. One other patient had regional wall motion abnormalities. Nineteen patients underwent coronary revascularization surgically and 8 percutaneously. Overall, flash pulmonary edema reoccurred in one half of the patients. Of the 19 patients who underwent coronary revascularization, by 6 months there was 1 death and 9 patients had been hospitalized with recurrent pulmonary edema.

Many patients with flash pulmonary edema have preserved systolic left ventricular function and coronary artery disease. Flash pulmonary edema frequently reoccurs in association with marked systolic hypertension, even after coronary revascularization. This suggests that control of hypertension is important and that coronary revascularization may not be adequate to prevent reoccurrence of flash pulmonary edema.