Approach to Acute Pulmonary Edema in ACS

Acute heart failure is a clinical syndrome characterised by the rapid onset and progression of breathlessness and exhaustion. There is usually fluid overload. The more severe presentations of acute heart failure are acute pulmonary edema and cardiogenic shock.The most common cause of heart failure is impaired myocardial function (cardiomyopathy) secondary to one or more of the following:• Hypertension(> 60%of patients with heart failure)• Ischemic heart disease(> 50%of patients with heart failure) more common in ACS setting • Idiopathic dilatation(10% of patients with heart failure)• Diabetes• Alcohol excess• Obesity • Drug toxicity , arrhythmias , valvular dysfunction ,pericardial disease.Noncardiac causes of heart failure are hypovolaemia (dehydration or haemorrhage), pulmonary embolism and high output states (anaemia, septicaemia and thyrotoxicosis).The goals of Acute pulmonary edema management are symptom relief, reduction of extracellular fluid excess, improved haemodynamics, improved arterial oxygenation and satisfactory perfusion of the vital organs beside management of acute coronary syndrome and revascularization in indicated patients.Anti ischemic therapy , diuretics , nitrates , oxygen supplement , respiratory supportive therapy, inotropes in selected patients and ventricular assists devices in resistant patients are commonly used treatments in acute pulmonary edema caused by myocardial infarction and ischemia.Post acute phase management included life style modification, investigate other comorbidities and treat them, risk factor management and heart failure standard medications(ACEI,BB,MRA,Diuretics,...).