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## Cardiac-Related Pulmonary Edema Pulmonary edema occurs when excess fluid enters the pulmonary interstitium and alveoli because of: * Increased pulmonary capillary pressure combined with decreased oncotic pressure * Mechanical or physiologic damage to the capillary-alveolar membrane, or obstruct...

## Cardiac-Related Pulmonary Edema Pulmonary edema occurs when excess fluid enters the pulmonary interstitium and alveoli because of: * Increased pulmonary capillary pressure combined with decreased oncotic pressure * Mechanical or physiologic damage to the capillary-alveolar membrane, or obstruction of the lymphatic drainage system ### How does this happen? * **Mitral stenosis** - reduces the flow of blood to the left ventricle. Pressure in the left atrium increases to overcome resistance, resulting in enlargement of the left atrium and increased pressure in the pulmonary veins and capillaries of the lung. * **Tachycardia and/or atrial fibrillation** - may reduce blood flow to the left ventricle, resulting in increased atrial and pulmonary pressure. * **Left ventricular dysfunction** - reduces cardiac output and fluid backs up into the lungs, increasing the capillary pressure. The increased pressure results in increased capillary vasodilation and fluid flows into the interstitium. Initially, lymphatic drainage increases to compensate but becomes overwhelmed as fluid accumulates. When the interstitium becomes engorged, the fluid crosses the alveolar membranes, and the alveoli cannot function, resulting in decreased gas exchange and hypoxemia. ## Cardiac Catheterization Cardiac catheterization in children is usually performed with IVs inserted into the femoral artery and vein, and a catheter advanced to the heart. Catheterization may be diagnostic or therapeutic. ### Before the procedure: * The child receives sedation and local anesthetic, with medications appropriate for age. ### Different procedures that can be completed during cardiac catheterization: * Performing biopsies * Injecting dye and performing angiograms * Withdrawing blood samples * Opening or enlarging the atrial septal defect * Placing stents * Placing occlusive devices * Using balloon inflation to widen narrowed vessels ### After the procedure: * Direct pressure is applied to the catheter insertion site for 10 minutes and then a pressure dressing is applied. * Vital signs and circulation in the leg (if femoral site used) are monitored closely. ### Complications: * Vascular injury * Anaphylaxis * Hypoventilation * Hypotension * Arrhythmias * Cardiac perforation * Emboli (systemic/pulmonary) * Cardiac arrest