Which medications are used for the treatment of cardiogenic pulmonary edema (CPE)?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Loop diuretics have long been the cornerstone of cardiogenic pulmonary edema (CPE) treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (eg, nitroglycerin [NTG]) and afterload (eg, angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.

Nesiritide is recombinant human brain-type natriuretic peptide (BNP); it reduces pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure, RA pressure, and systemic vascular resistance while increasing the cardiac index and stroke volume index. Therapy with nesiritide has decreased plasma renin, aldosterone, norepinephrine, and endothelin-1 levels and reduced ventricular ectopy and ventricular tachycardia. Heart-rate variability also improves with nesiritide. However, owing to the lack of positive outcomes data (ASCEND-HF) from the use of nesiritide, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure.

Inotropic support is usually used following unsuccessful attempts at preload and afterload reduction or when hypotension precludes the use of these strategies. The two main classes of inotropic agents that are available are catecholamine agents and phosphodiesterase inhibitors (PDIs).

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