Pulmonary Edema in Myocardial Infarction

Pathophysiology

Left ventricular infarctions lead to impaired left ventricular contractility, resulting in decreased cardiac output, increased left ventricular end-diastolic pressure, elevated left atrial pressure, increased pulmonary venous pressure, and pulmonary congestion and edema, as stated by the American College of Cardiology 1
Right ventricular infarction causes right ventricular dysfunction, decreased right ventricular output, reduced pulmonary blood flow, and less pulmonary congestion, according to the American College of Cardiology 2
The initial phase of right ventricular failure consists mainly of a severely dilated hypokinetic right ventricle, deviation of the interventricular septum into the left ventricle, and reduced preload to the left ventricle 3

The clinical triad of right ventricular infarction includes hypotension, clear lung fields, and elevated jugular venous pressure, as noted by the American College of Cardiology 2
Distended neck veins or Kussmaul's sign and ST-segment elevation in right precordial lead V4R are also predictive findings in right ventricular infarction 2
Upper lung zone flow redistribution, lung interstitial or alveolar edema, bilateral pleural effusions, and cardiac enlargement are radiographic findings associated with pulmonary edema 4

For left-sided MI with pulmonary edema, the American College of Cardiology recommends nitrates, diuretics for volume overload, oxygen therapy for hypoxemia, and possible need for mechanical ventilation in severe cases 1
For right-sided MI, the American College of Cardiology suggests volume loading, avoiding nitrates and diuretics, maintaining AV synchrony, and inotropic support if needed 2