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6/15/15ulmonary edema - Wikipedia, the free encyclopedia

Page ttps://en.wikipedia.org/wiki/Pulmonary_edema

Pulmonary edema

Pulmonary edema with small pleural effusions on both sides.

Classification and external resources

ICD-10 J81

(http://apps.who.int/classifications/icd10/browse/2015/en#/J

ICD-9 514 (http://www.icd9data.com/getICD9Code.ashx?icd9=514

518.4 (http://www.icd9data.com/getICD9Code.ashx?

icd9=518.4)

DiseasesDB 11017 (http://www.diseasesdatabase.com/ddb11017.htm)

MedlinePlus 000140

(http://www.nlm.nih.gov/medlineplus/ency/article/000140.h

eMedicine article/157452 (http://emedicine.medscape.com/article/1574

overview) article/300813

(http://emedicine.medscape.com/article/300813-overview),

article/360932 (http://emedicine.medscape.com/article/3609

overview)

MeSH D011654 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?

field=uid&term=D011654)

Pulmonary edemaFrom Wikipedia, the free encyclopedia

Pulmonary edema(American

English), or oedema(British English;

both words from the Greek !"#$%&), is

fluid accumulation in the airspaces andparenchyma of the lungs.[1]It leads to

mpairedgas exchange and may cause

respiratory failure. It is due to either

failure of the left ventricle of the heart

o adequatelyremove blood from the

pulmonary circulation ("cardiogenic

pulmonary edema"), or an injury to the

ung parenchyma or vasculature of the

ung ("noncardiogenic pulmonary

edema").[2]Treatment is focused onhree aspects: firstly improving

respiratory function, secondly, treating

he underlying cause, and thirdly

avoiding further damage to the lung.

Pulmonary edema, especially in the

acute setting, can lead to respiratory

distress, cardiac arrest due to hypoxia,

and death.

Contents

1 Symptoms and signs2 Causes

2.1 Cardiogenic2.2 Non-cardiogenic2.3 Other/unknown

3 Diagnosis4 Prevention5 Management

5.1 Cardiogenicpulmonary edema

6 References7 External links

Symptoms and signs
http://emedicine.medscape.com/article/300813-overviewhttp://emedicine.medscape.com/article/157452-overviewhttps://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000140.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000140.htmhttp://www.diseasesdatabase.com/ddb11017.htmhttp://www.icd9data.com/getICD9Code.ashx?icd9=518.4http://www.icd9data.com/getICD9Code.ashx?icd9=518.4http://apps.who.int/classifications/icd10/browse/2015/en#/J81http://apps.who.int/classifications/icd10/browse/2015/en#/J81https://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/File:PulmEdema.PNGhttps://en.wikipedia.org/wiki/Pulmonary_edema#External_linkshttps://en.wikipedia.org/wiki/Pulmonary_edema#External_linkshttps://en.wikipedia.org/wiki/Pulmonary_edema#External_linkshttps://en.wikipedia.org/wiki/Pulmonary_edema#Referenceshttps://en.wikipedia.org/wiki/Pulmonary_edema#Cardiogenic_pulmonary_edemahttps://en.wikipedia.org/wiki/Pulmonary_edema#Managementhttps://en.wikipedia.org/wiki/Pulmonary_edema#Cardiogenic_pulmonary_edemahttps://en.wikipedia.org/wiki/Pulmonary_edema#Preventionhttps://en.wikipedia.org/wiki/Pulmonary_edema#Diagnosishttps://en.wikipedia.org/wiki/Pulmonary_edema#Other.2Funknownhttps://en.wikipedia.org/wiki/Pulmonary_edema#Non-cardiogenichttps://en.wikipedia.org/wiki/Medical_Subject_Headingshttps://en.wikipedia.org/wiki/Pulmonary_edema#Cardiogenichttps://en.wikipedia.org/wiki/Pulmonary_edema#Causeshttps://en.wikipedia.org/wiki/Pulmonary_edema#Symptoms_and_signshttps://en.wikipedia.org/wiki/Respiratory_distresshttps://en.wikipedia.org/wiki/Diseases_Databasehttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-Ware-2https://en.wikipedia.org/wiki/Gas_exchangehttps://en.wikipedia.org/wiki/Parenchymahttps://en.wikipedia.org/wiki/Edemahttps://en.wikipedia.org/wiki/Greek_languagehttps://en.wikipedia.org/wiki/British_Englishhttps://en.wikipedia.org/wiki/Pulmonary_edema#External_linkshttps://en.wikipedia.org/wiki/Pulmonary_edema#Referenceshttps://en.wikipedia.org/wiki/Pulmonary_edema#Cardiogenic_pulmonary_edemahttps://en.wikipedia.org/wiki/Pulmonary_edema#Managementhttps://en.wikipedia.org/wiki/Pulmonary_edema#Preventionhttps://en.wikipedia.org/wiki/Pulmonary_edema#Diagnosishttps://en.wikipedia.org/wiki/Pulmonary_edema#Other.2Funknownhttps://en.wikipedia.org/wiki/Pulmonary_edema#Non-cardiogenichttps://en.wikipedia.org/wiki/Pulmonary_edema#Cardiogenichttps://en.wikipedia.org/wiki/Pulmonary_edema#Causeshttps://en.wikipedia.org/wiki/Pulmonary_edema#Symptoms_and_signshttps://en.wikipedia.org/wiki/Hypoxia_(medical)https://en.wikipedia.org/wiki/Respiratory_distresshttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-Ware-2https://en.wikipedia.org/wiki/Parenchymahttps://en.wikipedia.org/wiki/Pulmonaryhttps://en.wikipedia.org/wiki/Hearthttps://en.wikipedia.org/wiki/Left_ventriclehttps://en.wikipedia.org/wiki/Respiratory_failurehttps://en.wikipedia.org/wiki/Gas_exchangehttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-1https://en.wikipedia.org/wiki/Human_lunghttps://en.wikipedia.org/wiki/Parenchymahttps://en.wikipedia.org/wiki/Edemahttps://en.wikipedia.org/wiki/Greek_languagehttps://en.wikipedia.org/wiki/British_Englishhttps://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D011654https://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://emedicine.medscape.com/article/360932-overviewhttp://emedicine.medscape.com/article/300813-overviewhttp://emedicine.medscape.com/article/157452-overviewhttps://en.wikipedia.org/wiki/EMedicinehttp://www.nlm.nih.gov/medlineplus/ency/article/000140.htmhttps://en.wikipedia.org/wiki/MedlinePlushttp://www.diseasesdatabase.com/ddb11017.htmhttps://en.wikipedia.org/wiki/Diseases_Databasehttp://www.icd9data.com/getICD9Code.ashx?icd9=518.4http://www.icd9data.com/getICD9Code.ashx?icd9=514https://en.wikipedia.org/wiki/List_of_ICD-9_codeshttps://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://apps.who.int/classifications/icd10/browse/2015/en#/J81https://en.wikipedia.org/wiki/ICD-10https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttps://en.wikipedia.org/wiki/File:PulmEdema.PNG


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Pulmonary edema on CT-scan

(coronal MPR)

The overwhelming symptom of pulmonary edema is difficulty breathing, but may also include coughing up

blood (classically seen as pink, frothy sputum), excessive sweating, anxiety, and pale skin. Shortness of brea

can manifest as orthopnea (inability to lie down flat due to breathlessness) and/or paroxysmal nocturnal dysp

episodes of severe sudden breathlessness at night). These are common presenting symptoms of chronic

pulmonary edema due to left ventricular development of pulmonary edema may be associated with symptom

and signs of "fluid overload", this is a non specific term to describe the manifestations of left ventricular failu

on the rest of the body and includes peripheral edema (swelling of the legs, in general, of the "pitting" variety

wherein the skin is slow to return to normal when pressed upon), raised jugular venous pressure andhepatomegaly, where the liver is enlarged and may be tender or even pulsatile. Other signs include end-

nspiratory crackles (sounds heard at the end of a deep breath) on auscultation and the presence of a third hea

sound.[2]

Causes

Pulmonary edema is an accumulation of fluid within the parenchyma

and air spaces of the lungs. Classically it is cardiogenic (left ventricular)

but fluid may also accumulate due to damage to the lung. This damage

may be direct injury or injury mediated by high pressures within the

pulmonary circulation. When directly or indirectly caused by increased

eft ventricular pressure pulmonary edema may form when mean

pulmonary pressure rises from the normal of 15 mmHg[3]to above 25

mmHg.[4]Broadly, the causes of pulmonary edema can be divided into

cardiogenic and non-cardiogenic. By convention cardiogenic refers to

eft ventricular causes.

Cardiogenic

Left ventricular failure may be due to a heart attack leading toarrhythmias (tachycardia/fast heartbeat or bradycardia/slowheartbeat) and fluid overload, e.g., from kidney failure or intravenous therapy which may cause dilatatand failure of the left ventricle or may cause pulmonary edema in the absence of heart failure.

Non-cardiogenic

Hypertensive crisis. The cause of pulmonary edema in the presence of a hypertensive crisis is probablydue to a combination of increased pressures in the right ventricle and pulmonary circulation and also

increased systemic vascular resistance and left ventricle contractility increasing the hydrostatic pressurwithin the pulmonary capillaries leading to extravasation of fluid and edema.

Upper airway obstruction (negative pressure pulmonary edema[5])

Neurogenic causes[6](seizures, head trauma, strangulation, electrocution).

Other/unknown
https://en.wikipedia.org/wiki/Electrocutionhttps://en.wikipedia.org/wiki/Strangulationhttps://en.wikipedia.org/wiki/Seizureshttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-6https://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-5https://en.wikipedia.org/wiki/Edemahttps://en.wikipedia.org/wiki/Extravasationhttps://en.wikipedia.org/wiki/Capillarieshttps://en.wikipedia.org/wiki/Hydrostatic_pressurehttps://en.wikipedia.org/wiki/Contractilityhttps://en.wikipedia.org/wiki/Systemic_vascular_resistancehttps://en.wikipedia.org/wiki/Right_ventriclehttps://en.wikipedia.org/wiki/Hypertensive_crisishttps://en.wikipedia.org/wiki/Hypertensive_crisishttps://en.wikipedia.org/wiki/Intravenous_therapyhttps://en.wikipedia.org/wiki/Renal_failurehttps://en.wikipedia.org/wiki/Bradycardiahttps://en.wikipedia.org/wiki/Tachycardiahttps://en.wikipedia.org/wiki/Cardiac_arrhythmiahttps://en.wikipedia.org/wiki/Myocardial_infarctionhttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-4https://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-3https://en.wikipedia.org/wiki/Ventricle_(heart)https://en.wikipedia.org/wiki/Parenchymahttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-Ware-2https://en.wikipedia.org/wiki/Third_heart_soundhttps://en.wikipedia.org/wiki/Auscultationhttps://en.wikipedia.org/wiki/Crackleshttps://en.wikipedia.org/wiki/Hepatomegalyhttps://en.wikipedia.org/wiki/Jugular_venous_pressurehttps://en.wikipedia.org/wiki/Edemahttps://en.wikipedia.org/wiki/Paroxysmal_nocturnal_dyspneahttps://en.wikipedia.org/wiki/Orthopneahttps://en.wikipedia.org/wiki/Shortness_of_breathhttps://en.wikipedia.org/wiki/Pallorhttps://en.wikipedia.org/wiki/Anxietyhttps://en.wikipedia.org/wiki/Diaphoresishttps://en.wikipedia.org/wiki/Haemoptysishttps://en.wikipedia.org/wiki/Shortness_of_breathhttps://en.wikipedia.org/wiki/File:18-01-Lungenoedem_CT_coronar.png


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X-Ray showing pulmonary oedema

njury to the lung may also cause pulmonary oedema through injury to the vasculature and parenchyma of th

ung. The acute lung injury-acute respiratory distress syndrome (ALI-ARDS) covers many of these causes, b

hey may include:

Inhalation of hot or toxic gasesPulmonary contusion, i.e., high-energy trauma (e.g. vehicle accidents)Aspiration, e.g., gastric fluidReexpansion, i.e. post large volume thoracocentesis, resolution of pneumothorax, post decortication,

removal of endobronchial obstruction, effectively a form of negative pressure pulmonary oedema.Reperfusion injury, i.e. postpulmonary thromboendartectomy or lung transplantation

Immersion pulmonary edema[7][8]

Multiple blood transfusionsSevere infection or inflammation which may be local or systemic. This is the classical form of ALI-ARDS.

There are also a range of causes of pulmonary edema which are less well characterised and arguably represen

specific instances of the broader classifications above.

Arteriovenous malformationHantavirus pulmonary syndrome

High altitude pulmonary edema (HAPE), probably a manifestation of neurogenic pulmonary edema[9]

Envenomation, such as with the venom of Atrax robustus[11]

Flash pulmonary edemaSwimming induced pulmonary edema

Diagnosis

There is no one single test for confirming that breathlessness is caused

by pulmonary edema; indeed, in many cases, the cause of shortness of

breath is probably multifactorial.

Low oxygen saturation and disturbed arterial blood gas readings support

he proposed diagnosis by suggesting a pulmonary shunt. Chest X-ray

will show fluid in the alveolar walls, Kerley B lines, increased vascular

shadowing in a classical batwing peri-hilum pattern, upper lobe

diversion (increased blood flow to the superior parts of the lung), and

possibly pleural effusions. In contrast, patchy alveolar infiltrates are

more typically associated with noncardiogenic edema[2]

Especially in the case of cardiogenic pulmonary edema, urgent

echocardiography may strengthen the diagnosis by demonstrating

mpaired left ventricular function, high central venous pressures and

high pulmonary artery pressures.

Blood tests are performed for electrolytes (sodium, potassium) and markers of renal function (creatinine, ure

Liver enzymes, inflammatory markers (usually C-reactive protein) and a complete blood count as well as

coagulation studies (PT, aPTT) are also typically requested. B-type natriuretic peptide (BNP) is available in
https://en.wikipedia.org/wiki/Brain_natriuretic_peptidehttps://en.wikipedia.org/wiki/Coagulationhttps://en.wikipedia.org/wiki/Complete_blood_counthttps://en.wikipedia.org/wiki/C-reactive_proteinhttps://en.wikipedia.org/wiki/Liver_enzymehttps://en.wikipedia.org/wiki/Renal_functionhttps://en.wikipedia.org/wiki/Electrolytehttps://en.wikipedia.org/wiki/Pulmonary_arteryhttps://en.wikipedia.org/wiki/Central_venous_pressurehttps://en.wikipedia.org/wiki/Echocardiographyhttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-Ware-2https://en.wikipedia.org/wiki/Pleural_effusionhttps://en.wikipedia.org/wiki/Hilum_of_lunghttps://en.wikipedia.org/wiki/Kerley_B_lineshttps://en.wikipedia.org/wiki/X-rayhttps://en.wikipedia.org/wiki/Pulmonary_shunthttps://en.wikipedia.org/wiki/Arterial_blood_gashttps://en.wikipedia.org/wiki/Oxygen_saturationhttps://en.wikipedia.org/wiki/Swimming_induced_pulmonary_edemahttps://en.wikipedia.org/wiki/Flash_pulmonary_edemahttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-11https://en.wikipedia.org/wiki/Atrax_robustushttps://en.wikipedia.org/wiki/Envenomationhttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-10https://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-pmid18578641-9https://en.wikipedia.org/wiki/High_altitude_pulmonary_edemahttps://en.wikipedia.org/wiki/Hantavirushttps://en.wikipedia.org/wiki/Arteriovenous_malformationhttps://en.wikipedia.org/wiki/ARDShttps://en.wikipedia.org/wiki/Acute_lung_injuryhttps://en.wikipedia.org/wiki/Inflammationhttps://en.wikipedia.org/wiki/Infectionhttps://en.wikipedia.org/wiki/Blood_transfusionhttps://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-pmid15796313-8https://en.wikipedia.org/wiki/Pulmonary_edema#cite_note-pmid9068153-7https://en.wikipedia.org/wiki/Lung_transplantationhttps://en.wikipedia.org/wiki/Thromboendartectomyhttps://en.wikipedia.org/wiki/Thoracocentesishttps://en.wikipedia.org/wiki/Pulmonary_aspirationhttps://en.wikipedia.org/wiki/Physical_traumahttps://en.wikipedia.org/wiki/Pulmonary_contusionhttps://en.wikipedia.org/wiki/ARDShttps://en.wikipedia.org/wiki/Acute_lung_injuryhttps://en.wikipedia.org/wiki/File:Pulmonary_oedema.jpg


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many hospitals, sometimes even as a point-of-care test. Low levels of BNP (


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External links

pg=/ppdocs/us/common/dorlands/dorland/three/000033856.htm)" atDorland's Medical Dictionary

2. Ware LB, Matthay MA (December 2005). "Clinical practice. Acute pulmonary edema".N. Engl. J. Med.353(26): 27

96. doi:10.1056/NEJMcp052699 (https://dx.doi.org/10.1056%2FNEJMcp052699). PMID 16382065

(https://www.ncbi.nlm.nih.gov/pubmed/16382065).

3. What Is Pulmonary Hypertension? (http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_what.html) From Disease

and Conditions Index (DCI). National Heart, Lung, and Blood Institute. Last updated September 2008. Retrieved on

April 2009.

4. Chapter 41, page 210 in: Cardiology secrets (http://books.google.com/books?

id=IYFAsxAUA_MC&printsec=frontcover#PPR3,M1) By Olivia Vynn Adair Edition: 2, illustrated Published byElsevier Health Sciences, 2001 ISBN 1-56053-420-6, ISBN 978-1-56053-420-4

5. Papaioannou, V.; Terzi, I.; Dragoumanis, C.; Pneumatikos, I. (2009). "Negative-pressure acute tracheobronchial

hemorrhage and pulmonary edema" (http://www.springerlink.com/content/r7256106w24031lr/).Journal of Anesthes

23(3): 417420. doi:10.1007/s00540-009-0757-0 (https://dx.doi.org/10.1007%2Fs00540-009-0757-0).

6. O'Leary, R.; McKinlay, J. (2011). "Neurogenic pulmonary oedema". Continuing Education in Anaesthesia, Critical C

& Pain11(3): 8792. doi:10.1093/bjaceaccp/mkr006 (https://dx.doi.org/10.1093%2Fbjaceaccp%2Fmkr006).

7. Hampson NB, Dunford RG (1997). "Pulmonary edema of scuba divers" (http://archive.rubicon-foundation.org/2388)

Undersea Hyperb Med24(1): 2933. PMID 9068153 (https://www.ncbi.nlm.nih.gov/pubmed/9068153). Retrieved

2008-09-04.

8. Cochard G, Arvieux J, Lacour JM, Madouas G, Mongredien H, Arvieux CC (2005). "Pulmonary edema in scuba div

recurrence and fatal outcome" (http://archive.rubicon-foundation.org/4032). Undersea Hyperb Med32(1): 3944.

PMID 15796313 (https://www.ncbi.nlm.nih.gov/pubmed/15796313). Retrieved 2008-09-04.

9. Luks AM (2008). "Do we have a "best practice" for treating high altitude pulmonary edema?".High Alt. Med. Biol.9

(2): 1114. doi:10.1089/ham.2008.1017 (https://dx.doi.org/10.1089%2Fham.2008.1017). PMID 18578641


10. Bates, M (2007). "High altitude pulmonary edema" (http://www.altitude.org/altitude_sickness.php#HAPE). Altitude

Physiology Expeditions. Retrieved 2008-09-04.

11. White J, Gray M, Fisher M (1989). Atrax Robustus (http://www.inchem.org/documents/pims/animal/atrax.htm) IPCS

InChem

12. Richalet JP, Gratadour P, Robach P et al. (2005). "Sildenafil inhibits altitude-induced hypoxemia and pulmonary

hypertension".Am. J. Respir. Crit. Care Med.171(3): 27581. doi:10.1164/rccm.200406-804OC

(https://dx.doi.org/10.1164%2Frccm.200406-804OC). PMID 15516532

(https://www.ncbi.nlm.nih.gov/pubmed/15516532).13. Perimenis P (2005). "Sildenafil for the treatment of altitude-induced hypoxaemia".Expert Opin Pharmacother6(5):

8357. doi:10.1517/14656566.6.5.835 (https://dx.doi.org/10.1517%2F14656566.6.5.835). PMID 15934909


14. Clark, Michael; Kumar, Parveen J. (2009). Kumar and Clark's clinical medicine. St. Louis, Mo: Elsevier Saunders.

p. 783. ISBN 0-7020-2993-9.

15. Fagenholz PJ, Gutman JA, Murray AF, Harris NS (2007). "Treatment of high altitude pulmonary edema at 4240 m in

Nepal".High Alt. Med. Biol.8(2): 13946. doi:10.1089/ham.2007.3055

(https://dx.doi.org/10.1089%2Fham.2007.3055). PMID 17584008 (https://www.ncbi.nlm.nih.gov/pubmed/17584008

16. Cleland JG, Yassin AS, Khadjooi K (2010). "Acute heart failure: focusing on acute cardiogenic pulmonary oedema"

(http://www.clinmed.rcpjournal.org/content/10/1/59.long). Clin Med10(1): 5964. doi:10.7861/clinmedicine.10-1-5

(https://dx.doi.org/10.7861%2Fclinmedicine.10-1-59). PMID 20408310(https://www.ncbi.nlm.nih.gov/pubmed/20408310).

17. Vital FM, Ladeira MT, Atallah AN (2013). "Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for

cardiogenic pulmonary oedema" (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005351.pub3/full). Cochr

Database Syst Rev5: CD005351. doi:10.1002/14651858.CD005351.pub3

(https://dx.doi.org/10.1002%2F14651858.CD005351.pub3). PMID 23728654

https://www.ncbi.nlm.nih.gov/pubmed/23728654https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1002%2F14651858.CD005351.pub3https://en.wikipedia.org/wiki/Digital_object_identifierhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005351.pub3/fullhttps://www.ncbi.nlm.nih.gov/pubmed/20408310https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.7861%2Fclinmedicine.10-1-59https://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.clinmed.rcpjournal.org/content/10/1/59.longhttps://www.ncbi.nlm.nih.gov/pubmed/17584008https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1089%2Fham.2007.3055https://en.wikipedia.org/wiki/Digital_object_identifierhttps://en.wikipedia.org/wiki/Special:BookSources/0-7020-2993-9https://en.wikipedia.org/wiki/International_Standard_Book_Numberhttps://www.ncbi.nlm.nih.gov/pubmed/15934909https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1517%2F14656566.6.5.835https://en.wikipedia.org/wiki/Digital_object_identifierhttps://www.ncbi.nlm.nih.gov/pubmed/15516532https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1164%2Frccm.200406-804OChttps://en.wikipedia.org/wiki/Digital_object_identifierhttps://en.wikipedia.org/wiki/Pulmonary_hypertensionhttp://www.inchem.org/documents/pims/animal/atrax.htmhttp://www.altitude.org/altitude_sickness.php#HAPEhttps://www.ncbi.nlm.nih.gov/pubmed/18578641https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1089%2Fham.2008.1017https://en.wikipedia.org/wiki/Digital_object_identifierhttps://www.ncbi.nlm.nih.gov/pubmed/15796313https://en.wikipedia.org/wiki/PubMed_Identifierhttp://archive.rubicon-foundation.org/4032https://www.ncbi.nlm.nih.gov/pubmed/9068153https://en.wikipedia.org/wiki/PubMed_Identifierhttp://archive.rubicon-foundation.org/2388https://dx.doi.org/10.1093%2Fbjaceaccp%2Fmkr006https://en.wikipedia.org/wiki/Digital_object_identifierhttps://en.wikipedia.org/wiki/Continuing_Education_in_Anaesthesia,_Critical_Care_%26_Painhttps://dx.doi.org/10.1007%2Fs00540-009-0757-0https://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.springerlink.com/content/r7256106w24031lr/https://en.wikipedia.org/wiki/Special:BookSources/9781560534204https://en.wikipedia.org/wiki/Special:BookSources/1560534206http://books.google.com/books?id=IYFAsxAUA_MC&printsec=frontcover#PPR3,M1http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_what.htmlhttps://www.ncbi.nlm.nih.gov/pubmed/16382065https://en.wikipedia.org/wiki/PubMed_Identifierhttps://dx.doi.org/10.1056%2FNEJMcp052699https://en.wikipedia.org/wiki/Digital_object_identifierhttps://en.wikipedia.org/wiki/Dorland%27s_medical_reference_workshttp://web.archive.org/web/20090616022448/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/three/000033856.htm


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HeartFailureMatters.org (http://www.heartfailurematters.org/en_GB#journey) Animation showing HoHeart Failure causes Fluid Accumulation - Created by the European Heart Failure Association

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