Clinical investigations from the RACP

Investigating the patient with pulmonary oedema

M Andrew Fitzpatrick



Radiologically confirmed pulmonary oedema implies left heart failure until proved otherwise. The incidence will continue to increase as our population ages and, as not all patients require hospitalisation, GPs need to be confident about management.

Key Points

  • Pulmonary oedema should be confirmed by chest x-ray.
  • A detailed history, physical examination and basic laboratory tests are essential to identify exacerbating factors.
  • Patients with rapid onset of symptoms should be hospitalised.
  • Loop diuretic and ACE inhibitor therapy should be started while awaiting the results of initial investigations.
  • Echocardiography and specialist referral of selected patients are essential for definitive management.