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Pulmonary Edema

Pulmonary Edema is a topic covered in the 5-Minute Clinical Consult.

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  • Pulmonary capillaries leak fluid into the lung interstitium and alveoli, leading to hypoxia and respiratory distress.
  • Fluid accumulation results from cardiogenic causes (e.g., heart failure), leading to imbalanced hydrostatic and oncotic pressures within pulmonary capillaries or from noncardiogenic causes (e.g., acute lung injury) that increase alveolar membrane permeability.


  • Annual heart failure incidence: 960,000 cases
  • Heart failure incidence increases with age.
    • Age 35 to 64 years: 2 cases per 1,000
    • Age 65 to 69 years: 20 cases per 1,000
    • Age >85 years: >80 cases per 1,000
  • Disparities in heart failure incidence by race and sex
    • Blacks (16.3/1,000) versus whites (11.9/1,000)
    • Men (15.8/1,000) versus women (11.7/1,000)
  • Acute respiratory distress syndrome (ARDS): 190,000 cases annually in United States

Heart failure syndromes: 6.5 million U.S. adults

Etiology and Pathophysiology

  • Cardiogenic causes increase large vessel (and subsequently) pulmonary capillary hydrostatic pressure, leading to increased transvascular filtration of a protein-poor fluid into lung interstitium.
  • Systolic dysfunction is due to decreased contractility of the left ventricle (LV), leading to decreased cardiac output, which in turn stimulates the renin–angiotensin system and increases fluid retention. Diastolic dysfunction is often due to decreased LV compliance secondary to hypertrophy.
  • Cardiogenic (left-sided heart failure)
    • Impaired contractility
      • Ischemic heart disease
      • Dilated cardiomyopathy
      • Myocarditis
      • Volume overload
      • Alcoholic cardiomyopathy
    • Increased LV afterload
      • Systemic hypertension (HTN)
      • Aortic stenosis
      • Cocaine abuse
    • Poor diastolic filling
      • LV hypertrophy
      • Hypertrophic cardiomyopathy
      • Mitral stenosis
      • Atrial fibrillation
    • Valvular dysfunction
      • Mitral regurgitation
      • Acute papillary muscle rupture
    • High cardiac output states
      • Thyrotoxicosis
      • Systemic arteriovenous fistulas
      • Anemia
    • Noncompliance with medications or diet
    • Medications with negative inotropic effects
  • Noncardiogenic causes will increase permeability of the lung vasculature, leading to accumulation of protein-rich fluid in the lung interstitium and air spaces. Many causes of this vascular permeability are associated with ARDS.
  • Noncardiogenic
    • ARDS
    • Acute lung injury
    • Transfusion-related acute lung injury
    • Preeclampsia
    • Rapid ascent to high altitude (>2,500 m)
    • Drug toxicity (salicylates, opiates)
    • Embolism (thrombus, fat, air, amniotic fluid)
    • Neurogenic (after head trauma/surgery)
    • Reexpansion (after pneumothorax/thoracentesis)


Risk Factors

  • Cardiogenic: HTN, valvular disease, hyperlipidemia, atherosclerosis, diabetes mellitus, obesity, excessive alcohol intake, physical inactivity, dietary choices, and smoking
  • Noncardiogenic: sepsis, aspiration, pneumonia, trauma, inhaled toxins, DIC

General Prevention

Early detection and treatment of risk factors, including high blood pressure, diabetes, alcohol intake, obesity, and tobacco abuse

Commonly Associated Conditions

See “Etiology and Pathophysiology.”

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Stephens, Mark B., et al., editors. "Pulmonary Edema." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688211/all/Pulmonary_Edema.
Pulmonary Edema. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688211/all/Pulmonary_Edema. Accessed April 18, 2019.
Pulmonary Edema. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688211/all/Pulmonary_Edema
Pulmonary Edema [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688211/all/Pulmonary_Edema.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pulmonary Edema ID - 1688211 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688211/all/Pulmonary_Edema PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -