Congestive heart failure chest x ray: Difference between revisions

Jump to navigation Jump to search
 
(11 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{congestive heart failure}}
{| class="infobox" style="float:right;"
{{CMG}}; {{AOEIC}} {{LG}}
|-
| [[File:Siren.gif|30px|link= Heart failure resident survival guide]]|| <br> || <br>
| [[Heart failure resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
 
{{Congestive heart failure}}
{{CMG}}; {{AOEIC}} {{LG}} {{EdzelCo}}


== Overview==
== Overview==
The chest x-ray in a patient with heart failure shows [[cardiomegaly]] ([[cardiac enlargement]] and pulmonary congestion ([[Kerley B lines]], and in some cases [[pleural effusion]]).
[[Chest X-ray|Chest x-ray]] in a patient with [[heart failure]] shows [[cardiomegaly]] ([[cardiac enlargement]] and [[pulmonary congestion]] ([[Kerley B lines]], and in some cases [[pleural effusion]]).


==Chest X Ray==
==Chest X Ray==
*Since the left ventricle often dilates in the anteroposterior direction, the cardiac silhouette may appear deceptively normal.
*Since the [[left ventricle]] often dilates in the anteroposterior direction, the [[cardiac silhouette]] may appear deceptively normal.


*Chest x-ray findings include:
*[[Chest X-ray|Chest x-ray]] findings include:
#[[Kerley B lines]] or thickening of the interlobular septa
#[[Kerley B lines]] or thickening of the interlobular septa
#[[Peribronchial cuffing]]
#[[Peribronchial cuffing]]
#Thickening of the fissures
#Thickening of the [[fissures]]
#Cephalization
#[[Cephalization]]
#Increased vascular markings
#Increased [[vascular markings]]
#[[Interstitial edema]]
#[[Interstitial edema]]
#[[Pleural effusion]]s
#[[Pleural effusion]]s


====Kerley B Lines====
====Kerley B Lines====
[[Kerley B lines]] are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the [[pleura]]. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces.  They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.
[[Kerley B lines]] are short parallel lines at the [[lung]] periphery. These lines represent distended [[interlobular septa]], which are usually less than 1 cm in length and parallel to one another at right angles to the [[pleura]]. They are located peripherally in contact with the [[pleura]], but are generally absent along [[fissural]] surfaces.  They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.
<gallery>
<gallery>
Image:Kerley B 001.jpg|Plain film: [[Mitral stenosis]], Kerley B lines
Image:Kerley B 001.jpg|Plain film: [[Mitral stenosis]], [[Kerley B lines]]
Image:Kerley B 002.jpg|Plain film: [[Mitral stenosis]], Kerley B lines
Image:Kerley B 002.jpg|Plain film: [[Mitral stenosis]], [[Kerley B lines]]
Image:Kerley B 003.jpg|Plain film: [[Mitral stenosis]], Kerley B lines
Image:Kerley B 003.jpg|Plain film: [[Mitral stenosis]], [[Kerley B lines]]
</gallery>
</gallery>
<br clear="left"/>
<br clear="left"/>


====Peribronchial Cuffing====
====[[Peribronchial]] Cuffing====
[[Image:Peribronchial cuffing.png|thumb|left|The red arrows point to thickened bronchial walls that have a doughnut-like appearance.]] [[Peribronchial cuffing]] is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.<br clear="left"/>
[[Image:Peribronchial cuffing.png|thumb|left|The red arrows point to thickened [[bronchial]] walls that have a doughnut-like appearance.]] [[Peribronchial cuffing]] is an abnormality on a [[chest x-ray]] whereby the usually thin [[bronchial]] walls are thickened and take on a doughnut-like appearance.<br clear="left"/>


====Cephalization====
====[[Cephalization]]====
[[Image:Cephalization.png|left|thumb]]Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung.  This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity.  After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.<br clear="left"/>
[[Image:Cephalization.png|left|thumb]][[Cephalization on chest x-ray|Cephalization]] refers to the redistribution of [[blood]] into the [[upper lobe]] [[vessels]]. It has been hypothesized that once the [[hydrostatic pressure]] exceeds 10 mm Hg, then fluid begins to leak into the [[interstitium]] of the [[lung]].  This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity.  After this, the upper lobe [[vessels]] are recruited to distribute a greater volume of [[blood]]. In order to carry a greater volume of [[blood]], the upper lobe [[vessels]] increase in size.<br clear="left"/>


==Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema==
==Differentiating [[Cardiogenic]] Versus [[Noncardiogenic]] [[Pulmonary Edema]]==


===Cardiogenic Pulmonary Edema===
===[[Cardiogenic]] [[Pulmonary Edema]]===
[[Image:Interstitial edema.png|thumb|left]] Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema.
[[Image:Interstitial edema.png|thumb|left]] [[Cardiogenic]] [[pulmonary edema]] can be distinguished from noncardiogenic [[pulmonary edema]] by the presence of redistribution of [[blood flow]] to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema.
<br clear="left"/>
<br clear="left"/>


===Noncardiogenic Pulmonary Edema===
===Noncardiogenic Pulmonary Edema===
[[Image:Pulmonary alveolar edema.png|left|thumb]] In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema.
[[Image:Pulmonary alveolar edema.png|left|thumb]] In contrast, patchy [[alveolar]] infiltrates with [[air bronchograms]] are more indicative of [[noncardiogenic edema]].
<br clear="left"/>
<br clear="left"/>


==Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure==
==Correlation of [[Chest X-Ray]] Findings with [[Pulmonary Capillary Wedge Pressure]]==


*'''Normal''': 5-10 mm Hg
*'''Normal''': 5-10 mm Hg
*'''Cephalization''': 10-15 mm Hg
*'''[[Cephalization]]''': 10-15 mm Hg
*'''Kerley B Lines''': 15-20 mm Hg
*'''[[Kerley B Lines]]''': 15-20 mm Hg
*'''Pulmonary Interstitial Edema''': 20-25 mm Hg
*'''[[Pulmonary Interstitial Edema]]''': 20-25 mm Hg
* '''Pulmonary Alveolar Edema''': > 25 mm Hg
* '''[[Pulmonary Alveolar Edema]]''': > 25 mm Hg


==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
==Evaluation With [[Cardiac Imaging]] 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) <ref name="pmid35363500">{{cite journal| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM | display-authors=etal| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2022 | volume= 145 | issue= 18 | pages= e876-e894 | pmid=35363500 | doi=10.1161/CIR.0000000000001062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500  }} </ref> ==


===X Ray in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===


{|class="wikitable"
{|class="wikitable" style="width:80%"
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]


|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Twelve-lead [[electrocardiogram]] and [[Congestive heart failure chest x ray|chest radiograph]] (PA and lateral) should be performed initially in all patients presenting with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In [[patients]] with suspected or new-onset [[HF]], or those presenting with acute decompensated [[HF]], a [[chest]] [[X-ray]] should be performed to assess [[heart]] size and [[pulmonary congestion]] and to detect alternative [[cardiac]], [[pulmonary]], and other [[diseases]] that may cause or contribute to the [[patient]]'s [[symptoms]]. <ref name="pmid8945695">{{cite journal| author=Badgett RG, Mulrow CD, Otto PM, Ramírez G| title=How well can the chest radiograph diagnose left ventricular dysfunction? | journal=J Gen Intern Med | year= 1996 | volume= 11 | issue= 10 | pages= 625-34 | pmid=8945695 | doi=10.1007/BF02599031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8945695  }} </ref><ref name="pmid15006584">{{cite journal| author=Knudsen CW, Omland T, Clopton P, Westheim A, Abraham WT, Storrow AB | display-authors=etal| title=Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. | journal=Am J Med | year= 2004 | volume= 116 | issue= 6 | pages= 363-8 | pmid=15006584 | doi=10.1016/j.amjmed.2003.10.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15006584  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=15341468 Review in: ACP J Club. 2004 Sep-Oct;141(2):48] </ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki>
 
|}
|}


Line 68: Line 72:


==Sources==
==Sources==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>


Line 74: Line 80:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date cardiology]]
[[Category:Primary care]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 20:46, 22 June 2022



Resident
Survival
Guide
Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure chest x ray On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure chest x ray

CDC on Congestive heart failure chest x ray

Congestive heart failure chest x ray in the news

Blogs on Congestive heart failure chest x ray

Directions to Hospitals Treating Congestive heart failure chest x ray

Risk calculators and risk factors for Congestive heart failure chest x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2] Edzel Lorraine Co, DMD, MD[3]

Overview

Chest x-ray in a patient with heart failure shows cardiomegaly (cardiac enlargement and pulmonary congestion (Kerley B lines, and in some cases pleural effusion).

Chest X Ray

  1. Kerley B lines or thickening of the interlobular septa
  2. Peribronchial cuffing
  3. Thickening of the fissures
  4. Cephalization
  5. Increased vascular markings
  6. Interstitial edema
  7. Pleural effusions

Kerley B Lines

Kerley B lines are short parallel lines at the lung periphery. These lines represent distended interlobular septa, which are usually less than 1 cm in length and parallel to one another at right angles to the pleura. They are located peripherally in contact with the pleura, but are generally absent along fissural surfaces. They may be seen in any zone but are most frequently observed at the lung bases at the costophrenic angles on the PA radiograph, and in the substernal region on lateral radiographs.


Peribronchial Cuffing

The red arrows point to thickened bronchial walls that have a doughnut-like appearance.

Peribronchial cuffing is an abnormality on a chest x-ray whereby the usually thin bronchial walls are thickened and take on a doughnut-like appearance.

Cephalization

Cephalization refers to the redistribution of blood into the upper lobe vessels. It has been hypothesized that once the hydrostatic pressure exceeds 10 mm Hg, then fluid begins to leak into the interstitium of the lung. This excess fluid initially compresses the lower lobe vessels, perhaps as a result of gravity. After this, the upper lobe vessels are recruited to distribute a greater volume of blood. In order to carry a greater volume of blood, the upper lobe vessels increase in size.

Differentiating Cardiogenic Versus Noncardiogenic Pulmonary Edema

Cardiogenic Pulmonary Edema

Cardiogenic pulmonary edema can be distinguished from noncardiogenic pulmonary edema by the presence of redistribution of blood flow to the upper lobes (increased blood flow to the higher parts of the lung) and interstitial edema.


Noncardiogenic Pulmonary Edema

In contrast, patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema.


Correlation of Chest X-Ray Findings with Pulmonary Capillary Wedge Pressure

Evaluation With Cardiac Imaging 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [1]

Class I
"1. In patients with suspected or new-onset HF, or those presenting with acute decompensated HF, a chest X-ray should be performed to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient's symptoms. [2][3](Level of Evidence: C-LD) "

Vote on and Suggest Revisions to the Current Guidelines

Sources

References

  1. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  2. Badgett RG, Mulrow CD, Otto PM, Ramírez G (1996). "How well can the chest radiograph diagnose left ventricular dysfunction?". J Gen Intern Med. 11 (10): 625–34. doi:10.1007/BF02599031. PMID 8945695.
  3. Knudsen CW, Omland T, Clopton P, Westheim A, Abraham WT, Storrow AB; et al. (2004). "Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea". Am J Med. 116 (6): 363–8. doi:10.1016/j.amjmed.2003.10.028. PMID 15006584. Review in: ACP J Club. 2004 Sep-Oct;141(2):48
  4. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).
  5. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  6. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967

Template:WikiDoc Sources