Mohamed, a listener from Sudan, emailed asking about the treatment of acute pulmonary edema in patients with low blood pressure. This is in distinction to SCAPE patients (see podcast 1).

If the patients have pulmonary edema and low BP from a cardiac cause, then they are in

Cardiogenic shock.

First, consider the etiology:

* Rate-related

* Valve Disorder

* Ischemic (Right sided infarct, STEMI, NSTEMI)

* Cardiomyopathy

* Toxicologic

At the same time, you are treating the patient with:

* Inotropes (dobutamine, milrinone, calcium)

* Pressors to achieve a MAP > 65 (allows coronary perfusion) (Meta-Analysis demonstrates norepi superior to dopamine Medicine. 96(43):e8402, OCT 2017)

* Oxygenation support, most likely with intubation

* Optimize O2 carrying capacity (Hb>10)

Here is a fantastic set of guidelines to manage these patients

Update:

* Contemporary Management of Cardiogenic Shock Circulation 2017;136:e232

* Journal Feed Summary