239. Cardiogenic and non-cardiogenic acute pulmonary edema in hypertensive disorder in pregnancy

Abstract

Introduction Acute pulmonary edema (APE) in hypertensive disorder in pregnancy (HDP) is one of the serious conditions and may have various origins, which roughly classified into non-cardiogenic(NCPE) and cardiogenic (CPE). Treatment strategy may be different from each other. Objective Similarity and difference of symptoms, physical or laboratory findings, and treatment between NCPE and CPE were investigated and appropriate approach may be established. Methods The HDP cases which had acute dyspnea and underwent echocardiography in our hospital between January 2014 and March 2018 were recruited to the study. The medical records were retrospectively reviewed. Results Twenty HDP cases were reviewed. Sixteen cases were confirmed as NCPE including one beta-adrenergic drug-induced, two transfusions related, which were mainly treated with diuretics. Based on the echocardiography findings, four cases were confirmed as CPE all of which were diagnosed with peripartum cardiomyopathy (PPCM). While only one NCPE case had orthopnea, all of CPE cases did. Furthermore, most of NCPE cases showed systemic edema, but none of CPE cases did not. No significant difference was observed in other clinical or laboratory findings between two groups. Discussion Orthopnea is known to be a typical symptom of heart failure. CPE is basically caused by pulmonary congestion followed by left heart dysfunction. From this study, it could be one of the characteristic symptoms of CPE. Severe hypertension may sometimes increase afterload leading to left heart dysfunction. NCPE was the most common cause of dyspnea in HDP, but it may come from various situation Hyperpermeability and hypoosmolality, are essential features of HDP. Some medical interventions such as steroid for fetal lung maturation, and beta-adrenergic drugs for tocolysis may possibly cause NCPE. Infusion overload or transfusion-related acute lung injury may sometimes accompany with serious conditions of HDP such as placental abruption, HELLP syndrome.