Congestive heart failure and pulmonary edema for the emergency physician.

Congestive heart failure (CHF) and pulmonary edema are major health problems in the United States as well as across the rest of the developing world. The prevalence of CHF and pulmonary edema in the general population results in a significant number of these patients presenting to Emergency Departments (EDs). Mortality from these disorders is substantial, with a 5-year mortality rate for patients requiring hospitalization of approximately 50%. Understanding of the clinical syndromes of CHF and pulmonary edema requires review of the basic determinants of cardiovascular performance. Preload, afterload, contractility, and heart rate may all be modified by pharmacological or mechanical techniques. Diuretics, vasodilators, cardiac glycosides, and other inotropes all may play a role in the ED management of CHF. In rare instances, mechanical devices for support of the heart and circulation may be indicated.