{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:51:53Z","timestamp":1790596313494,"version":"4.1.0"},"reference-count":78,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Cardiogenic pulmonary edema (CPE) is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung\u2019s alveolar spaces due to an elevated cardiac filling pressure. All cardiac diseases, characterized by an increasing pressure in the left side of the heart, can cause CPE. High capillary pressure for an extended period can also cause barrier disruption, which implies increased permeability and fluid transfer into the alveoli, leading to edema and atelectasis. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Some studies claim that these patients may have higher levels of surfactant protein B in the bloodstream. The correct approach to patients with CPE should include a detailed medical history and a physical examination to evaluate signs and symptoms of CPE as well as potential causes. Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should occur in the meantime. The identification of the specific CPE phenotype is essential to set the most appropriate therapy for these patients. Non-invasive ventilation (NIV) should be considered early in the treatment of this disease. Diuretics and vasodilators are used for pulmonary congestion. Hypoperfusion requires treatment with inotropes and occasionally vasopressors. Patients with persistent symptoms and diuretic resistance might benefit from additional approaches (i.e., beta-agonists and pentoxifylline). This paper reviews the pathophysiology, clinical presentation, and management of CPE.<\/jats:p>","DOI":"10.3390\/arm91050034","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T10:16:12Z","timestamp":1697192172000},"page":"445-463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Cardiogenic Pulmonary Edema in Emergency Medicine"],"prefix":"10.3390","volume":"91","author":[{"given":"Christian","family":"Zanza","sequence":"first","affiliation":[{"name":"Post Graduate School of Geriatric Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"},{"name":"Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8767-6577","authenticated-orcid":false,"given":"Francesco","family":"Saglietti","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfredi","family":"Tesauro","sequence":"additional","affiliation":[{"name":"Post Graduate School of Geriatric Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"},{"name":"Department of Systems Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA"},{"name":"Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-5435","authenticated-orcid":false,"given":"Gabriele","family":"Savioli","sequence":"additional","affiliation":[{"name":"Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Giosu\u00e8","family":"Balzanelli","sequence":"additional","affiliation":[{"name":"Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsiana","family":"Romenskaya","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3120-6178","authenticated-orcid":false,"given":"Luigi","family":"Cofone","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8004-5537","authenticated-orcid":false,"given":"Ivano","family":"Pindinello","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Racca","sequence":"additional","affiliation":[{"name":"Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Racca","sequence":"additional","affiliation":[{"name":"Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3958","DOI":"10.1161\/CIRCULATIONAHA.105.590091","article-title":"International Working Group on Acute Heart Failure Syndromes. 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