The Pathogenesis of Acute Pulmonary Edema Associated with Hypertension
Sanjay K. Gandhi, M.D., John C. Powers, M.D., Abdel-Mohsen Nomeir, M.D., Karen Fowle, R.T., R.D.C.S., Dalane W. Kitzman, M.D., Kevin M. Rankin, M.D., and William C. Little, M.D.
Background Patients with acute pulmonary edema often have markedhypertension but, after reduction of the blood pressure, havea normal left ventricular ejection fraction (0.50). However,the pulmonary edema may not have resulted from isolated diastolicdysfunction but, instead, may be due to transient systolic dysfunction,acute mitral regurgitation, or both.
Methods We studied 38 patients (14 men and 24 women; mean [±SD]age, 67±13 years) with acute pulmonary edema and systolicblood pressure greater than 160 mm Hg. We evaluated the ejectionfraction and regional function by two-dimensional Doppler echocardiography,both during the acute episode and one to three days after treatment.
Results The mean systolic blood pressure was 200±26 mmHg during the initial echocardiographic examination and wasreduced to 139±17 mm Hg (P< 0.05) at the time of thefollow-up examination. Despite the marked difference in bloodpressure, the ejection fraction was similar during the acuteepisode (0.50±0.15) and after treatment (0.50±0.13).The left ventricular regional wall-motion index (the mean valuefor 16 segments) was also the same during the acute episode(1.6±0.6) and after treatment (1.6±0.6). No patienthad severe mitral regurgitation during the acute episode. Eighteenpatients had a normal ejection fraction (at least 0.50) aftertreatment. In 16 of these 18 patients, the ejection fractionwas at least 0.50 during the acute episode.
Conclusions In patients with hypertensive pulmonary edema, anormal ejection fraction after treatment suggests that the edemawas due to the exacerbation of diastolic dysfunction by hypertension— not to transient systolic dysfunction or mitral regurgitation.
Source Information
From the Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, N.C.
Address reprint requests to Dr. Little at the Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1045, or at wlittle{at}wfubmc.edu.
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