The Pathogenesis of Acute Pulmonary Edema Associated with Hypertension

• Published in: The New England journal of medicine Vol. 344; no. 1; pp. 17 - 22
• Main Authors: Gandhi, Sanjay K, Powers, John C, Nomeir, Abdel-Mohsen, Fowle, Karen, Kitzman, Dalane W, Rankin, Kevin M, Little, William C
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 04-01-2001
• Subjects: Acute Disease; Aged; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Cardiology; Cardiovascular system; Diastole; Diuretics - therapeutic use; Echocardiography, Doppler; Female; Follow-Up Studies; Heart attacks; Heart failure; Heart Failure - etiology; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Hypotheses; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Mitral Valve Insufficiency - complications; Pulmonary Edema - diagnostic imaging; Pulmonary Edema - drug therapy; Pulmonary Edema - etiology; Radiography; Stroke Volume; Ultrasonic imaging; Ultrasonic investigative techniques; Vasodilator Agents - therapeutic use; Ventricular Dysfunction, Left - complications; Ventricular Function, Left; Sonography; Human; Hypertension; Lung disease; Edema; Echocardiography; Radiodiagnosis; Pathophysiology; Respiratory disease; Acute; Lung; Cardiovascular disease; Association; Medical imagery; Comparative study
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM200101043440103

It is a clinical paradox that patients hospitalized with congestive heart failure may later be noted to have normal systolic function, as evidenced by a normal left ventricular ejection fraction (≥0.50).
1
–
5
In this situation, the heart failure has been presumed to be due to isolated diastolic dysfunction.
6
For example, Vasan and Levy proposed that a normal left ventricular ejection fraction (of at least 0.50) within 72 hours after an episode of pulmonary congestion indicates that the patient had heart failure due to diastolic, rather than systolic, dysfunction.
7
Patients often have marked hypertension when they present with acute pulmonary edema. . . .