Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 124

In acute MI, pulmonary edema results from volume redistribution to the lungs without overt volume overload and sometimes without LV dilatation. Treatment consists of small doses of furosemide (e.g., 20–40 mg IV), along with a low dose of intravenous NTG to reduce preload. Excessive preload or afterload reduction may, however, precipitate shock.

Severe HF (Killip class III), i.e., massive pulmonary edema that frequently requires mechanical ventilation, is an indication for primary PCI of the culprit artery irrespective of the delay to presentation (approach similar to cardiogenic shock).^1,2

Conversely, less severe HF with late presentation (>24 hours) and no residual angina does not dictate urgent PCI. Coronary angiography and PCI may be performed on a non-urgent basis if HF, i.e., severe functional limitation, persists after initial diuresis; otherwise, stress testing may be performed first to assess for residual ischemia.