Acute pulmonary edema and unstable coronary disease

The 30-day mortality of the APE remains high.In 216 consecutive patients admitted with PAD in a single center, mortality was 14.1%. 2 Among the modalities of acute cardiac insufficiency, it occupies the second place in hospital cost, the cardiogenic shock is the first one.3 Breathless is the main symptom of HF and in APE is usually very intense.The differential diagnosis of dyspnea in the emergency room is broad, but the main diseases to be excluded due to the severity and risk of death are HF, acute coronary syndrome (ACS) and pulmonary embolism.4 In cardiogenic APE, the causes are, in particular, the diseases affecting the left heart, namely, systemic arterial hypertension, ischemic heart disease, aortic stenosis, mitral valvopathy cardiomyopathy and, in non cardiogenic, pneumonia and sepsis, trauma, bronchoaspiration and transfusion-related acute lung injury (TRALI).The exact mechanism of sudden increase in pulmonary capillary pressure in the cardiogenic APE is poorly understood, but the pathophysiological factor admitted is the loss of myocardial compliance, and the main cause attributed to this loss is myocardial ischemia with or without an acute ischemic event, causing ventricular dysfunction left.5