Clinical presentation and pharmacological therapy in patients with cardiogenic pulmonary oedema

Cardiogenic pulmonary oedema is a typical clinical presentation of acute heart failure and is associated with a poor outcome. Therapeutic strategies in patients with this condition have not yet been uniformly developed and are based on expert consensus rather than results of randomised studies. The underlying aetiology seems to be one of the most important factors influencing therapy.

To evaluate treatment of patients with acute cardiogenic pulmonary oedema.

The analysed group consisted of 276 consecutive patients who were treated due to acute cardiogenic pulmonary oedema in two cardiac centres in the city of Łódź between 1998 and 2000. Clinical characteristics, aetiology and therapy were retrospectively analysed based on medical records.

Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic Results. Fifty nine (21%) patients died in hospital whereas the remaining 218 subjects were discharged. Etiologic factors included a marked elevation of blood pressure (BP) (29%), acute myocardial infarction (MI) (25%), unstable angina (16%), decompensation of valvular disorder (9%), respiratory tract infection (8%) and paroxysmal atrial fibrillation (4%). The highest in-hospital mortality (35%) was associated with acute MI, and the lowest (6%) - with BP elevation. The most frequently used agents during in-hospital stay were diuretics (89%), followed by antibiotics (84%) and acetylsalicylic acid (81%). Compared with survivors, patients who died during hospital stay were significantly more frequently treated with catecholamines (59% vs 7%, p<0.00001), corticosteroids (71% vs 15%, p<0.00001) and morphine (62% vs 41%, p<0.0015) whereas angiotensin converting enzyme inhibitors, intravenous nitroglycerine, beta-blockers and acetylsalicylic acid were less frequently used in deceased patients (34% vs 89%, p<0.00001; 52% vs 78%, p<0.00001; 14% vs 37%, p<0.001; and 64% vs 86%, p<0.0003, respectively).

In spite of intensive pharmacotherapy, cardiogenic pulmonary oedema is still associated with a high in-hospital mortality. Therapy should be tailored according to aetiology. Differences in pharmacological treatment between survivors and deceased patients depict better prognosis in those who have on admission normal or elevated blood pressure which enables an early administration of vasodilators and beta-blockers.