Cardiogenic Pulmonary Oedema (CPO) / Acute Left Ventricular Failure - ED Revision
Overview
Cardiogenic pulmonary oedema (CPO) is the acute accumulation of fluid in the lungs caused by raised pulmonary venous pressure due to left ventricular dysfunction. It commonly presents with sudden severe breathlessness, hypoxaemia and increased work of breathing, and can progress rapidly to respiratory failure or cardiogenic shock.
In the ED the priorities are rapid recognition, immediate supportive therapy to correct hypoxaemia and relieve congestion, identification of reversible precipitants (acute coronary syndrome, arrhythmia, hypertensive crisis, valvular lesion) and early escalation to cardiology/critical care when needed.
Follow NICE CG187 for diagnostic thresholds and initial management principles.
Pathophysiology (concise)
When left ventricular systolic or diastolic function fails, left atrial pressure rises, pulmonary venous and capillary hydrostatic pressure increases, and fluid transudates into the interstitium and alveoli.
Key precipitants or amplifiers:
- Increased preload (e.g. fluid overload, acute mitral regurgitation).
- Increased afterload (e.g. acute severe hypertension).
- Reduced cardiac output (e.g. ischaemia, arrhythmia).
Flash pulmonary oedema denotes very rapid onset (minutes-hours), often associated with an acute hypertensive surge, acute valvular dysfunction or arrhythmia.