Cardiogenic pulmonary edema and its absence in cardiac tamponade and constriction. A role for atrial natriuretic factor?

(Chest 1992; 101:258-60) P ulmonary edema may be anticipated in patients with cardiac failure and high central circulatory pressures as reflected in pulmonary artery wedge levels of 20 to 30 mm Hg,’ but does not occur at the same pressure levels with pencardial compression of the heart.2 Yet, in the systemic circulation, both rightsided cardiac failure and compressive pencardial disorders cause comparable venous congestion with sodium and fluid retention, and, in contrast to their strikingly different pulmonary parenchymal effects, both can provoke peripheral edema. The absence of pulmonary edema in cardiac tamponade and constriction remains unsatisfactorily explained. Indeed, the very rare patient developing pulmonary edema only upon relief of pericardial compression may have had acute cardiac failure due to underlying heart disease,3 or pulmonary parenchymal injury with or without volume overload from intravenous fluid therapy of tamponade.