Professional Documents
Culture Documents
Ilmiah Jantung
Ilmiah Jantung
Oedema
by:
Muhammad Zhikron Octoprima Orsal
Nadhirah Sa’an
Nurul Khairantih
Roji Dhia Nurman
Siti Umi Kustiah
74,4 Millon
incidence rate (IR) in Indonesia
10,17%, 19,24%
Literature Review
Definition
UK
Nieminen MS, Bohm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al. Executive su
mmary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J. 20
05
Non cardiogenic
occurs due to transudation of fluid from
the pulmonary capillaries into the
interstitial space and lung alveoli
resulting from abnormalities besides
heart.
Harun S dan Sally N. Edema Paru Akut. 2009. In: Sudoyo AW, Setiyohadi B, Alwi I, Sim
adibrata M, Setiati S, editor. Buku ajar ilmu penyakit dalam. 5th Ed.
B. Noncardiac causes
1. Pulmonary venous fibrosis
2. Congenital stenosis of the origin of
3. Pulmonary venoocclusive disease
3. Decreased oncotic pressure
Hypoalbuminemia from any cause
(renal , hepatic, nutritional, or protein-los
ing enteropathy).
4. Lymphatic insufficiency
as a result of lung transplantation, lymph
angiectatic carcinomatosis, or fibrosis ly
mphangitis.
Nieminen MS, Bohm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al. E
xecutive summary of the guidelines on the diagnosis and treatment of acute heart
failure. Eur Heart J. 2005
5. Mixed or unknown mechanisms
A. High-altitude pulmonary edema
altitude above 2700 meters, presumably the
mechanism is hypoxia because altitude causes
pulmo arteriole vasoconstr and excessive activity
stimulates increases of CO and pulmonary artery
pressure, resulting in PE.
Harun S dan Sally N. Edema Paru Akut. 2009. In: Sudoyo AW, Setiyohadi B, Alwi I,
Simadibrata M, Setiati S, editor. Buku ajar ilmu penyakit dalam. 5th Ed.
• LAW STARLING
Q(iv-int)=Kf[(Piv-Pint) – df(Iiv-Iint)]
Q = the rate of transudation of a
blood vessel into the interstitial space
Piv = intravascular hydrostatic
pressure
Pint = interstitial hydrostatic pressure
Iiv = intravascular colloidal osmotic
pressure
Iint = interstitial colloid osmotic
pressure
Df = protein reflection coefficient
Kf = hydraulic condensation
Harun S dan Sally N. Edema Paru Akut. 2009. In: Sudoyo AW, Setiyohadi B, Alwi I, Sim
adibrata M, Setiati S, editor. Buku ajar ilmu penyakit dalam. 5th Ed.
Lorraine et al. Acute Pulmonary Edema. N Engl J Med. 2005
Acute pulmonary non-cardiogenic edema after extubation with laryngospasm: a case report. Researchgate. 2018
Diagnosis
History
Physical Examination
Supporting Investigation
The following two fundamentally different types of pulmonary ed
ema occur in humans:
Noncardiogenic pulmo
nary edema (also known
Cardiogenic pulmonary as increased-permeability
edema (also termed hydr pulmonary edema, acute
ostatic or hemodynamic lung injury, or acute respi
edema) ratory distress syndrome)
.
Although they have distinct causes, cardiogenic and noncardiogenic pulmonary edema may be
difficult to distinguish because of their similar clinical manifestations.
Diagnosis
1. Laboratory tests
2. Chest Radiograph
3. Transthoracic Echocardiogram
4. Pulmonary Artery Catheterization
5. Electrocardiogram
CHEST RADIOGRAPH
Source : Assaad S, Kratzert WB, Shelley B, Friedman MB, Jr AP. Assessment of Pulmonary
Edema : Principles and Practice. 2018;32:901–14.
Laboratory tests
Supportive
supportive management is useful for finding and tre
ating the cause. What must be done is:
- Supports cardiovascular
- Fluid therapy
- Kidney support
- Management of sepsis
Ventilation
*
*
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
Recommendation pharmacotherapy for management of patients with AHF
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
*
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2016
Inotropes and /or Vasopressors
Prognostic
Parissis JT, Nikolaou M, Mebazaa A, Ikonomidis I, Delgado J, Boas FV, et al. acute
pulmonary oedema: clinical, characteristics,
prognostic factors, and in-hospital management. European Journal of Heart Failure.
2010;12:1193-1202
Closing
Summary
The diagnosis of acute pulm
Acute pulmonary onary edema can be
edema can be divided identified through the history
into cardiogenic and of the patient's symptoms,
non cardiogenic. physical examination, and
investigation.
Treatment of acute
pulmonary edema is
aimed at the primary
disease.
Thank you