Dear Editor
I read with interest the review article by Laffey et al. on Acute Respiratory Distress Syndrome (ARDS). As stated, one of the main differential diagnoses is of acute (cardiogenic) pulmonary oedema. Updated guidelines from the European Society of Cardiology recommend measuring plasma natriuretic peptides (NP’s) in all patients with acute dyspnoea to help in the differentiation of acute heart failure (AHF) from non-cardiac causes. NP’s have high sensitivity, and normal levels in patients with suspected AHF make the diagnosis unlikely (1). This should then alert the clinician to other causes of bilateral air space opacification on a chest x-ray such as ARDS. Likewise if AHF is suspected then prompt intravenous diuretic should be given (2).
References
(1) Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016 (8):891-975.
(2) Matsue Y, Damman K, Voors AA et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol. 2017;69(25):3042-3051
Rapid Response:
Re: Acute respiratory distress syndrome
Dear Editor
I read with interest the review article by Laffey et al. on Acute Respiratory Distress Syndrome (ARDS). As stated, one of the main differential diagnoses is of acute (cardiogenic) pulmonary oedema. Updated guidelines from the European Society of Cardiology recommend measuring plasma natriuretic peptides (NP’s) in all patients with acute dyspnoea to help in the differentiation of acute heart failure (AHF) from non-cardiac causes. NP’s have high sensitivity, and normal levels in patients with suspected AHF make the diagnosis unlikely (1). This should then alert the clinician to other causes of bilateral air space opacification on a chest x-ray such as ARDS. Likewise if AHF is suspected then prompt intravenous diuretic should be given (2).
References
(1) Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016 (8):891-975.
(2) Matsue Y, Damman K, Voors AA et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol. 2017;69(25):3042-3051
Competing interests: No competing interests