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October 28, 1939

CARDIAC ASTHMA AND ACUTE PULMONARY EDEMA COMPLICATING TOXEMIAS OF PREGNANCYFURTHER OBSERVATIONS

JAMA. 1939;113(18):1628-1631. doi:10.1001/jama.1939.02800430020005
Abstract

Recently we called attention to an interesting and dramatic symptom complex which occasionally complicates the severe nonconvulsive toxemias of pregnancy.1 It is characterized by the sudden appearance in a previously comfortable patient of extreme orthopnea, dyspnea, cyanosis and cough productive of frothy and often pinkish sputum. Numerous crepitant rales appear with the onset of the attack, and they persist, at least in the lung bases, for a variable period thereafter. Attacks have usually occurred in patients while at rest in bed. They closely resemble severe attacks of cardiac asthma such as occur characteristically in nonpregnant persons with conditions that impose a burden on the left venticle, notably severe hypertensive disease, aortic insufficiency and nephritis with hypertension.

We referred to this complication of nonconvulsive toxemias of pregnancy as "cardiac asthma and acute pulmonary edema." It has been encountered only in patients with severe toxemia. Hypertension, albuminuria and edema, all of

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