title: [Acute heart failure: acute cardiogenic pulmonary edema and cardiogenic shock].
abstract: Acute cardiogenic pulmonary edema and cardiogenic shock are two of the main forms of presentation of acute heart failure. Both entities are serious, with high mortality, and require early diagnosis and prompt and aggressive management. Acute pulmonary edema is due to the passage of fluid through the alveolarcapillary membrane and is usually the result of an acute cardiac episode. Correct evaluation and clinical identification of the process is essential in the management of acute pulmonary edema. The initial aim of treatment is to ensure hemodynamic stability and to correct hypoxemia. Other measures that can be used are vasodilators such as nitroglycerin, loop diuretics and, in specific instances, opioids. Cardiogenic shock is characterized by sustained hypoperfusion, pulmonary wedge pressure > 18 mmHg and a cardiac index < 2.2l/min/m(2). The process typically presents with hypotension (systolic blood pressure < 90 mmHg or a decrease in mean arterial pressure > 30 mmHg) and absent or reduced diuresis (< 0.5 ml/kg/h). The most common cause is left ventricular failure due to acute myocardial infarction. Treatment consists of general measures to reverse acidosis and hypoxemia, as well as the use of vasopressors and inotropic drugs. Early coronary revascularization has been demonstrated to improve survival in shock associated with ischaemic heart disease.
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez Marteles
authors.affiliation: Unidad de Insuficiencia Cardíaca, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España. Electronic address: agustinurrutia.germanstrias@gencat.cat.
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
mesh_terms: D000208:Acute Disease; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004231:Diuresis; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D009204:Myocardial Revascularization; D009294:Narcotics / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D012121:Respiration, Artificial; D018805:Sepsis / Q000175:diagnosis; D012769:Shock / Q000175:diagnosis; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy
chemical_list: D002317:Cardiovascular Agents; D009294:Narcotics; D049994:Sodium Potassium Chloride Symporter Inhibitors; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents
keywords: Acute heart failure; Cardiogenic pulmonary edema; Cardiogenic shock; Edema agudo de pulmón; Insuficiencia cardíaca aguda; Shock cardiogénico