Sympathetic crashing acute pulmonary edema
| Sympathetic crashing acute pulmonary edema | |
|---|---|
| Other names: Flash pulmonary edema, acute hypertensive heart failure, hypertensive cardiogenic pulmonary edema[1] | |
| Ultrasound of the lungs showing edema due to severe systolic heart failure[2] | |
 | |
| Specialty | Critical care |
| Symptoms | Shortness of breath, coughing frothy pink sputum[1] |
| Usual onset | Sudden[1] |
| Risk factors | Hypertension, heart failure, renal artery stenosis[1] |
| Diagnostic method | Low oxygen, mean arterial pressure > 120 mmHg, ultrasound of lungs[1] |
| Differential diagnosis | ARDS, STEMI, valvular heart disease[1] |
| Treatment | NIPPV, intravenous nitroglycerin[3] |
| Prognosis | Generally resolves rapidly though may recur[1] |
| Frequency | Relatively common[3] |
Sympathetic crashing acute pulmonary edema (SCAPE), also known as flash pulmonary edema, is a severe form of pulmonary edema.[3] Symptoms are sudden in onset and include severe shortness of breath.[1] People may also cough up frothy pink sputum, be sweaty, and experience agitation.[1] Wheezing or lung crackles may also be present.[4] Onset is typically over minutes to hours.[4]
Triggers may include not taking blood pressure medication, stimulant use, and stress.[1] Risk factors include hypertension, heart failure, and renal artery stenosis.[1] The underlying mechanism involves activation of the sympathetic nervous system which narrows blood vessels.[1][5] While fluid is present in the lung, fluid overload is typically not present.[1] Diagnosis is supported by low oxygen, mean arterial pressure > 120 mmHg, and ultrasound of the lungs.[1] It is a type of acute decompensated heart failure.[3]
Typically recommended initial treatments include non invasive positive pressure ventilation (NIPPV) and intravenous nitroglycerin.[3][6] NIPPV should use high pressures of 15 to 18 cm H2O and large amounts of nitroglycerin are typically required.[1] If this is insufficient clevidipine, nicardipine, or enalaprilat may be used.[1] Routine use of diuretics, such as furosemide, is not recommended.[3] It generally resolves rapidly, though may recur.[1] It is a relatively common reason to present to the emergency room.[3]
Signs and symptoms
Symptoms are sudden in onset and include severe shortness of breath.[1] People may also cough up frothy pink sputum, be sweaty, and experience agitation.[1] Wheezing or lung crackles may also be present.[4] Onset is typically over minutes to hours.[4] Generally there is little swelling of the legs.[7]
Diagnosis
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Diagnosis requires the presence of high blood pressure and if this is not present than other types of cardiogenic shock should be suspected.[7]
Treatment
Initial treatments include non invasive positive pressure ventilation (NIPPV) and intravenous nitroglycerin.[3] An arterial line may be useful in management.[7]
Medications
Nitroglycerin should be increased until the systolic blood pressure is less than 140 mmHg after which doses can be rapidly decreased.[1] Initial doses are often started at 400 to 800 mcg/min for 2 to 3 minutes followed by 100 to 300 mcg/min.[1] Lower doses may be required in aortic stenosis.[1] Unlike in other hypertensive emergencies, blood pressure can be rapidly reduced.[1] Beta blockers and opioids should generally not be used.[1] Use of furosemide is not needed in early treatment.[7]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 "Sympathetic Crashing Acute Pulmonary Edema (SCAPE)". EMCrit Project. Archived from the original on 9 March 2024. Retrieved 21 May 2024.
- ↑ "UOTW #48 – Ultrasound of the Week". Ultrasound of the Week. 23 May 2015. Archived from the original on 9 May 2017. Retrieved 27 May 2017.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Agrawal, N; Kumar, A; Aggarwal, P; Jamshed, N (December 2016). "Sympathetic crashing acute pulmonary edema". Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine. 20 (12): 719–723. doi:10.4103/0972-5229.195710. PMID 28149030.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ↑ 4.0 4.1 4.2 4.3 Brice, Jane H.; Delbridge, Theodore R.; Myers, J. Brent (8 November 2021). Emergency Medical Services, 2 Volumes: Clinical Practice and Systems Oversight. John Wiley & Sons. p. 52. ISBN 978-1-119-75624-8. Archived from the original on 25 May 2024. Retrieved 24 May 2024.
- ↑ Google Boeken. Wolters Kluwer India Pvt Ltd. 2022. p. 27. ISBN 978-93-90612-65-9. Archived from the original on 25 May 2024. Retrieved 24 May 2024.
- ↑ Long, Brit; Brady, William J.; Gottlieb, Michael (April 2025). "Emergency medicine updates: Sympathetic crashing acute pulmonary edema". The American Journal of Emergency Medicine. 90: 35–40. doi:10.1016/j.ajem.2024.12.061. PMID 39799613.
- ↑ 7.0 7.1 7.2 7.3 Borshoff, David (2018). The Resuscitation Crisis Manual. Leeuwin Press. ISBN 9780648270201.