Differentiation between cardiogenic and permeability pulmonary oedema

1. History. In many cases the diagnosis will be obvious.There may be history of previous myocardial infarction, hypertension, valvular heart disease, or episodes of cardiac failure.The sudden onset of an arrhythmia, such as atrial fibrillation, may cause sudden cardiac decompensation. If none of these is found, the presence of a known precipitating factor for noncardiogenic oedema should be sought.

2. Clinical examination. Physical signs tend to be similar.Tachycardia, cool peripheries, respiratory distress, frothy sputum, cyanosis, and basal and parasternal crepitations, feature in both. In primary cardiac disease there may be obvious cardiac enlargement, murmurs or an arrhythmia.An added third sound points to a cardiac cause.

3. Chest X-ray may show cardiac enlargement in addition to the pulmonary oedema.

4. ECG may show evidence of infarction, an arrhythmia, or chamber hypertrophy.

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