title: The vital role of the right ventricle in the pathogenesis of acute pulmonary edema.
abstract: The development of acute pulmonary edema involves a complex interplay between the capillary hydrostatic, interstitial hydrostatic, and oncotic pressures and the capillary permeability. We review the pathophysiological processes involved and illustrate the concepts in a number of common clinical situations including heart failure with normal and reduced ejection fractions, mitral regurgitation, and arrhythmias. We also describe other rarer causes including exercise, swimming, and diving-induced acute pulmonary edema. We suggest a unifying framework in which the critical abnormality is a mismatch or imbalance between the right and left ventricular stroke volumes. In conclusion, we hypothesize that increased right ventricular contraction is an important contributor to the sudden increase in capillary hydrostatic pressure, and therefore, a central mechanism involved in the development of alveolar edema.
authors.affiliation: Department of Cardiology, Taunton and Somerset Hospital, Taunton, United Kingdom; Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom; Medical Education, University of Bristol, Bristol, United Kingdom. Electronic address: david.maciver@tst.nhs.uk.
authors.forename: David H
authors.initials: DH
authors.lastname: MacIver
authors.affiliation: Department of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000208:Acute Disease; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*