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Acute hypertensive pulmonary edema: a new paradigm

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Although acute hypertensive pulmonary edema is sometimes regarded as the most severe form of heart failure, at the peak of symptoms, hearts perform well above resting levels and cannot be said to be failing. Another characteristic of the condition, the rapidity of its onset and reversal when properly treated, suggests positive feedback as a causal mechanism. It is proposed that the syndrome results from a feedback loop with increased sympathetic tone as the efferent output, increased pulmonary vascular pressure as the stimulus to increased sympathetic tone, and positive feedback occurring because elevated sympathetic tone constricts systemic veins, thereby transferring blood from peripheral veins to the pulmonary vasculature. Evidence for the proposed mechanism derives from all the empirical treatments that have evolved. All remove blood from the pulmonary circuit, and all but the oldest, bloodletting, do so by transferring blood from the pulmonary circuit to the peripheral veins.

L’œdème pulmonaire aigu est parfois considéré comme la forme la plus grave de l’insuffisance cardiaque. Toutefois, au pic des symptômes, les cœurs fonctionnent bien au-delà du seuil de repos, et ne peuvent donc pas être dits défaillants. Une autre caractéristique de l’état, son évolution rapide et son renversement rapide lorsqu’il est traité de manière adéquate, donne à penser qu’une rétroaction positive serait le mécanisme causal. On propose que le syndrome résulte d’une boucle de rétroaction dans laquelle l’augmentation du tonus sympathique est la voie efférente, l’augmentation de la pression vasculaire pulmonaire le stimulus de l’augmentation du tonus sympathique, et la rétroaction positive la conséquence de l’augmentation du tonus sympathique, qui entraîne une diminution du calibre des veines systémiques et, du même coup, le transfert du sang des veines périphériques au système vasculaire pulmonaire. Le mécanisme proposé est le fruit de l’évolution de tous les traitements empiriques utilisés. Tous éliminent le sang du circuit pulmonaire, et tous, sauf le premier, la saignée, le font en transférant le sang du circuit pulmonaire aux veines périphériques.

Document Type: Research Article

Publication date: January 1, 2010

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