Oedema is one of the fundamental features of heart failure, but the pathophysiology of oedema varies. Patients present along a spectrum ranging from acute pulmonary oedema to gross fluid retention and peripheral oedema (anasarca). In patients with pure pulmonary oedema, the problem is one of acute haemodynamic derangement; the patient does not have excess fluid, but pulmonary venous pressure rises such that the rate of fluid transudation into the interstitium of the lung exceeds the capacity of the pulmonary lymphatics to drain away the fluid. Conversely, in patients with peripheral oedema, the problem is one of fluid retention. Understanding the causes of oedema will enable straightforward, correct management of the condition. For patients with acute pulmonary oedema, vasodilatation is important to reduce cardiac filling pressures. For patients with fluid retention, removing the fluid, using either diuretics or mechanical means, is the most important consideration.
Oedema is one of the fundamental features of heart failure
Clinical trial data to guide best practice in managing cardiac oedema are lacking
Acute pulmonary oedema is characterized by accumulation of fluid in the air spaces, not by fluid overload
Acute pulmonary oedema is best treated as a haemodynamic problem using vasodilators
Peripheral oedema is characterized by an excess of total body water
Peripheral oedema is best treated by removing fluid, either with diuretics or mechanically
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A. L. Clark declares that he is on the advisory board for Novartis. J. G. F. Cleland declares that he has been a consultant for and received grants from Amgen and Novartis.
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Clark, A., Cleland, J. Causes and treatment of oedema in patients with heart failure. Nat Rev Cardiol 10, 156–170 (2013). https://doi.org/10.1038/nrcardio.2012.191
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