Pulmonary edema

Description

Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the many air sacs in the lungs, making breathing difficult.

In most cases, heart problems cause pulmonary edema. But fluid can accumulate in the lungs for other reasons. These include pneumonia, contact with certain toxins and medications, trauma to the chest wall, and traveling or exercising at high elevations.

Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that requires immediate attention. Pulmonary edema can sometimes cause death. Early treatment can help. Treatment for pulmonary edema depends upon the cause, but usually includes additional oxygen and medications.

Symptoms

Pulmonary Edema, the symptoms can appear suddenly or develop over time. The symptoms depend on the type of pulmonary edema.

Sudden (acute) pulmonary edema symptoms

  • Difficulty breathing (dyspnea) or extreme shortness of breath that gets worse with activity or when lying down
  • A feeling of suffocation or drowning, that gets worse when lying down
  • A cough that produces sputum sparkling that may have blood
  • A rapid, irregular heartbeat (palpitations)
  • Anxiety, restlessness or a feeling that something bad is about to happen
  • Cold, clammy skin
  • Wheezing or gasping for breath

Long-term (chronic) lung edema signs and symptoms

  • Wake up in the night with a cough or difficulty breathing. the feeling that may be relieved by sitting
  • Shortness of breath with activity or when lying down
  • Fatigue
  • More shortness of breath than usual when you're physically active
  • New or worsening cough
  • Rapid weight gain
  • Swelling in the legs and feet
  • Wheezing

High-altitude pulmonary edema (HAPE) of the signs and symptoms

high-altitude pulmonary edema (HAPE) can occur in adults and children who travel to or the exercise at high altitudes. The symptoms are similar to those that occur with acute pulmonary edema and may include:

  • Headache, which may be the first symptom
  • Shortness of breath with activity, which becomes shortness of breath at rest
  • Not being able to exercise as much as you once could
  • Dry cough, in the first
  • Later, a cough that produces sputum sparkling look of pink or blood
  • A very fast heartbeat (tachycardia)
  • Weakness
  • Pain in the chest
  • Low fever

The symptoms of altitude pulmonary edema (HAPE) tend to be worse at night.

When to see a doctor

The pulmonary edema that occurs suddenly (acute pulmonary edema) is a potentially life-threatening. Call 911 or emergency medical help if you have any of the following severe symptoms:

  • Shortness of breath, especially if it comes suddenly
  • Difficulty breathing or a feeling of suffocation (dyspnea)
  • A bubbling, wheezing or wheezing sound when breathing
  • Cough with phlegm which appears pink or bloody
  • Difficulty breathing with a lot of sweat
  • Blue or gray color to skin
  • The confusion
  • A big drop in the blood pressure, causing lightheadedness, dizziness, weakness or sweating
  • A sudden worsening of any of pulmonary edema symptoms

Do not drive yourself to the hospital. Instead, call 911 or emergency medical care and wait for help.

Causes

The causes of pulmonary edema vary. Pulmonary edema is divided into two categories, depending on where the problem starts.

  • If a heart problem causes pulmonary edema, is called cardiogenic pulmonary oedema. Most often, the accumulation of fluid in the lungs is due to a heart condition.
  • If pulmonary edema is not related to the heart, it is called non-cardiogenic pulmonary edema.
  • Sometimes, pulmonary edema may be caused by a heart problem and a nonheart problem.

The understanding of the relationship between the lungs and the heart may help to explain why the pulmonary edema may occur.

How the lungs work

The lungs contain many of the tiny, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide. Normally, this gas exchange occurs without problems.

But sometimes, the alveoli fill with fluid instead of air. This keeps the blood stream to take in oxygen.

How the heart works

The typical heart consists of two upper and two lower chambers. The upper chambers (the right and left atria) receive blood and pump it into the lower chambers (right and left ventricles). The lower chambers pump the blood out of the heart.

Normally, the blood without oxygen throughout the body enters the right atrium then the right ventricle. From there it is pumped through the large blood vessels (pulmonary artery) to the lungs. There, the blood releases carbon dioxide and picks up oxygen as it flows through the alveoli.

The oxygen-rich blood then returns to the left atrium through the pulmonary veins. It then flows through the mitral valve into the left ventricle. Finally, it leaves the heart through the body's main artery (aorta).

The valves of the heart keep blood flowing in the right direction. The aortic valve keeps the flow of blood back toward the heart. Of the aorta, the blood is distributed to the rest of the body.

Associated with the heart (cardiogenic) pulmonary edema

The cardiogenic pulmonary oedema is caused by the increase of the pressures in the heart.

It is usually a result of heart failure. When a sick or overworked from the lower left chamber of the heart (the left ventricle) is not able to pump sufficient amount of blood received from the lungs, the pressure in the heart of climbing. The increased pressure pushes the liquid through the walls of the blood vessels into the air sacs.

The medical conditions that can cause heart failure and lead to pulmonary edema include:

  • Disease of the coronary artery.Over time, the arteries that supply blood to the heart muscle can become close-up of fatty deposits (plaques). A slow narrowing of the coronary arteries, it can weaken the left ventricle. Sometimes, a blood clot forms in one of these narrowed arteries. The clot blocks the blood flow and damages part of the heart muscle, resulting in a heart attack. Damage to the heart muscle can't pump as well as it should.
  • The cardiomyopathy. This term means that the damage to the heart muscle. With cardiomyopathy, the heart has to pump harder, and the pressure increase. Then, the heart may not be able to work more hard when necessary, such as during exercise or with an infection or an increase in blood pressure. When the left ventricle can not keep up with the demands being placed on it, the fluid accumulates in the lungs.
  • Heart valve problems. Narrowing (stenosis) of the aortic or mitral heart valves or a valve that leaks or is not closed properly affects the flow of blood towards the heart. An exhaust valve that develops suddenly could cause a severe pulmonary edema.
  • High blood pressure (hypertension). Untreated or uncontrolled high blood pressure can enlarge the heart.
  • Other heart problems. Inflammation of the heart muscle (myocarditis), problems with the heart present at birth (congenital heart defects), and irregular heart rhythms (arrhythmias) can also cause pulmonary edema.
  • Kidney disease. High blood pressure due to narrowing of kidney arteries (renal artery stenosis), or the accumulation of fluid due to disease of the kidneys may cause pulmonary edema.
  • Chronic health conditions. Thyroid disease and a buildup of iron (hemochromatosis) or proteins (amyloidosis) can also contribute to heart failure and cause pulmonary edema.

Disease of the coronary artery. Over time, the arteries that supply blood to the heart muscle can become close-up of fatty deposits (plaques). A slow narrowing of the coronary arteries, it can weaken the left ventricle.

Sometimes, a blood clot forms in one of these narrowed arteries. The clot blocks the blood flow and damages part of the heart muscle, resulting in a heart attack. Damage to the heart muscle can't pump as well as it should.

Not related to the heart (noncardiogenic) pulmonary edema

Pulmonary edema is not caused by increased pressure in the heart is called pulmonary edema non-cardiogenic.

Causes of non-cardiogenic pulmonary edema include:

  • Acute respiratory distress syndrome (ARDS). This serious disorder that occurs when the lungs suddenly filled with fluid. Many conditions can cause acute respiratory distress syndrome (ARDS), including serious injury (trauma), generalized infection (sepsis), pneumonia, and severe hemorrhage.
  • The drug reaction or overdose of drugs. Many of the drugs — ranging from aspirin to illegal drugs like heroin and cocaine are known to cause pulmonary edema.
  • Blood clot in the lungs (pulmonary embolism). A blood clot in the movement of the blood vessels in the legs to the lungs can cause pulmonary edema.
  • Exposure to certain toxins. The inhalation of toxins or breathing in some of the contents of the stomach when the vomiting (aspiration) cause intense irritation of the small airways and alveoli, resulting in the accumulation of fluid.
  • The high altitudes. Pulmonary edema has been seen in mountain climbers, skiers, hikers and other people who travel to high elevations, usually above 8,000 feet (2400 meters). High-altitude pulmonary edema (HAPE) usually occurs in those who do not take days or weeks needed to be used for lifting. But the people who live at high altitudes can get the EPA with no elevation change, if you have a respiratory illness.
  • Near drowning. The inhalation of water causes the accumulation of fluid in the lungs.
  • Negative pressure pulmonary Edema. An obstruction of the upper airway causes a negative pressure in the lungs trying to breathe through the obstruction. With treatment, most people with this type of pulmonary edema are recovered in about 24 hours.
  • Nervous system conditions or surgeries. A type of pulmonary edema called neurogenic pulmonary edema can occur after a head injury, seizures, or brain surgery.
  • The inhalation of smoke. The smoke of a fire contains chemicals that damage the membrane between the alveoli and the capillaries. The damage allows fluid to enter the lungs.
  • Transfusion-related lung injury. Blood transfusions can cause fluid overload in the left ventricle, which leads to pulmonary edema.
  • Viral diseases. Viruses, such as the hantavirus and dengue virus can cause pulmonary edema.

Risk factors

Heart failure and other heart conditions that increase pressure on the heart, increasing the risk of pulmonary edema. Risk factors for heart failure include:

  • Irregular heart rhythms (arrhythmias)
  • The use of Alcohol
  • Congenital heart disease
  • Coronary artery disease
  • Diabetes
  • Heart valve disease
  • High blood pressure
  • Sleep apnea

Some diseases of the nervous system and lung damage, due to the near-drowning, drug use, the inhalation of smoke, viral infections, and blood clots also increases the risk.

People who travel to high altitude places above 8,000 feet (about 2,400 feet) are more prone to develop high-altitude pulmonary edema (HAPE). In general, it affects those who do not take the time — a couple of days, a week or more — to get used to the height.

Children who already have pulmonary hypertension and structural heart defects may be more likely to get the EPA .

Complications

Complications of pulmonary edema depend on the cause.

In general, if the pulmonary edema continues, the pressure in the pulmonary artery may increase (pulmonary hypertension). Finally, the heart weakens and begins to fail, and the pressures in the heart and lungs up.

Pulmonary Edema complications may include:

  • The difficulty of breathing
  • Swelling of the legs, the feet and the abdominal area.
  • Accumulation of fluid in the membranes surrounding the lungs (pleural effusion)
  • Congestion and inflammation of the liver

The immediate treatment is required for acute pulmonary edema to avoid death.

Prevention

You may be able to prevent the pulmonary edema management existing heart or lung conditions and following a healthy lifestyle.

For example, control cholesterol and blood pressure can help reduce the risk of heart disease. Follow these tips to keep your heart healthy:

  • Eating a healthy diet rich in fresh fruits, vegetables, whole grains, fat-free or low-fat dairy products, and a variety of proteins.
  • Do not smoke.
  • Get regular exercise.
  • Limit the consumption of salt and alcohol.
  • Manage stress.
  • Control the weight.

The prevention of high altitude pulmonary edema (HAPE)

To prevent the EPA , slowly ascend to the heights. Although recommendations vary, most experts advise that the increase of the elevation of not more than 1,000 to 1,200 feet (around 300 to 360 m) in a day once you get to 8,200 feet (2,500 meters).

Some of the climbers taking prescription drugs, such as acetazolamide or nifedipine (Procardia), to help prevent the symptoms of the EPA . To prevent the EPA , start taking the medication for at least a day before ascension. Ask your doctor how long you should take the medication after having reached its high altitude destination.

Pulmonary edema

Diagnosis

Breathing problems require immediate diagnosis and treatment. A health care provider can base a diagnosis of pulmonary edema on the symptoms and results of a physical examination and some tests.

Once the condition is more stable, the doctor may ask about your medical history, especially a history of cardiovascular disease or pulmonary disease.

The tests that can help diagnose pulmonary edema or to determine the reason of fluid in the lungs include:

  • X-ray of the chest. A chest x-ray can confirm the diagnosis of pulmonary edema and to exclude other possible causes of shortness of breath. Usually, it is the first test that is done when a doctor suspected of pulmonary edema.
  • Chest computed tomography scan (CT scan). A chest computed tomography (CT) gives more details about the condition of the lungs. It can help a doctor diagnose or rule out pulmonary edema.
  • Pulse oximetry. A sensor is connected to a finger or an ear. The light is used to determine the amount of oxygen in the blood.
  • Arterial Blood Gas Analysis. This test measures the amount of oxygen and carbon dioxide in the blood.
  • B-type natriuretic peptide (BNP) blood test. The increased levels of B-type natriuretic peptide (BNP) may be a sign of a heart condition.
  • Other blood tests. Blood tests to diagnose pulmonary edema and its causes, will also usually include a complete blood count, metabolic panel to evaluate the renal function and thyroid function test.
  • Electrocardiogram (ECG or EKG). This painless test detects and records the time and the strength of the heart signals. Uses small sensors (electrodes) that is attached on the chest and sometimes the arms or legs. Connect the cables from the sensors to a machine, which displays or prints the results. An electrocardiogram (ECG) may show signs of heart wall thickening or previous heart attack. A portable device, such as a Holter monitor can be used to continuously monitor the heart beat at home.
  • The echocardiogram. An echocardiogram uses sound waves (ultrasound) to create images of the beating heart. It can identify areas of poor blood flow, problems in the heart valves and heart muscle that is not working properly. An echocardiogram can help to diagnose the fluid around the heart (pericardial effusion).
  • Cardiac catheterization and coronary angiography. This test may be done if other tests do not show the cause of a pulmonary edema, or when there's also pain in the chest. Helps health care providers to see blockages in the arteries of the heart. A long, flexible tube (catheter) that is inserted into a blood vessel, usually in the groin or wrist. Is guided into the heart. Contrast dye flows through the catheter into the arteries in the heart. The dye helps the arteries to show up more clearly on X-ray images and video.
  • Ultrasound of the lungs. This painless test that uses sound waves to measure the flow of blood through the lungs. It can quickly reveal signs of fluid accumulation, and the plural of the spill.

Treatment

The first treatment for acute pulmonary edema is the oxygen. The oxygen flows through a mask or a flexible plastic tube with two openings (nasal cannula), which provide oxygen to each side of the nose. This should relieve some of the symptoms.

A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine, such as a mechanical ventilator, or one that provides positive pressure in the airways.

Depending on the severity of the condition and the reason for the pulmonary edema, the treatment may include one or more of the following medications:

  • Diuretics. Diuretics, such as furosemide (Lasix), a decrease in pressure caused by excess fluid in the lungs and the heart.
  • Blood pressure drugs. These help you manage the high or low blood pressure, which can occur with pulmonary edema. A doctor may also prescribe medications that decrease the pressure to get in or out of the heart. Some examples of these medications include nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).
  • Inotropes. This type of medication is given through an IV for the people in the hospital with severe congestive heart failure. Inotropes to improve the pumping function of the heart and keep the blood pressure.
  • Morphine (MS Contin, Infumorph, other). This narcotics may be taken by mouth or given through an INTRAVENOUS line to relieve the shortness of breath and anxiety. But some care providers believe that the risks of morphine may outweigh the benefits. They are more likely to use other drugs.

It is important for the diagnosis and the treatment, if possible, any problems of the nervous system or the causes of heart failure.

The treatment of high-altitude pulmonary edema (HAPE)

The oxygen is usually the first treatment. If oxygen is not available, a portable hyperbaric chamber can imitate to descend to a lower elevation until it is possible to move to a lower elevation.

Treatment of high altitude pulmonary edema (HAPE) also include:

  • Immediately goes down to a lower elevation. For someone in the high altitudes that have mild symptoms of high altitude pulmonary edema (HAPE), from 1,000 to 3,000 ft (about 300 to 1,000 meters) as soon as possible can help. Someone with severe EPA may need help of the rescue down the mountain.
  • Stop doing exercises and staying warm. The physical activity and the cold can cause pulmonary edema worse.
  • The medication. Some of the climbers taking prescription drugs, such as acetazolamide or nifedipine (Procardia) to help treat or prevent the symptoms of the EPA . To prevent the EPA , start taking the medication for at least a day before to go higher.

Self-care

Lifestyle changes are an important part of the health of the heart and can help with some forms of pulmonary edema.

  • Keep your blood pressure under control. For high blood pressure, taking your medications as prescribed to control the blood pressure regularly. Record the results. A health care provider can help you set a goal blood pressure.
  • The management of other medical conditions. Address underlying medical conditions. For example, the control of blood glucose levels if you have diabetes.
  • Avoid the cause of your condition. If the pulmonary edema of the results of the use of drugs or of great height, for example, avoiding the use of drugs, or being in the high altitudes may help to prevent further damage to the lungs.
  • Do not smoke. It is always a good idea to stop smoking. To help you stop smoking, talk with a health care provider.
  • Eat less salt. The salt helps the body to retain fluid. In some people with damage in the left ventricle of the heart, too much salt can trigger congestive heart failure. A dietitian can help with the reduction of the salt showing how to determine the salt content in the food and create a nutritious and delicious diet. In general, most people should consume less than 2,300 milligrams per day of salt (sodium). Ask your care provider what level it is safe for you.
  • Choose a healthy diet. A healthy diet that includes many fruits, vegetables and whole grains. Limit saturated fats and trans fats, sugars, and sodium.
  • Control the weight . Being even a little overweight increases the risk of cardiovascular disease. But the loss of even small amounts of weight can lower blood pressure and cholesterol and reduce the risk of diabetes.
  • Get regular exercise. Healthy adults should do at least 150 minutes of moderate aerobic activity or 75 minutes of aerobic activity, vigorous week, or a combination of the two. If you're not used to exercising, start slowly and gradually increase. Be sure to get your care provider's OK before you start an exercise program.

Preparing for your appointment

If you have pulmonary edema, it is likely that the first to be seen by a doctor in the emergency department. If you think you have signs or symptoms of pulmonary edema, call 911 or emergency medical help instead of making a patient consultation.

You can see several specialists, while you are in the hospital. After that you are stable, you may be referred to a doctor trained in heart disease (cardiologist) or lung diseases (pulmonologist).

What you can do

  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
  • Note if you have had similar symptoms in the past, even if you do not see a health care provider.
  • Write down key personal information, including any major stresses or recent life changes.
  • Obtain copies of your medical records whenever possible. Information to the hospital, and the results of tests of the heart, as well as the letters of the specialists that I have seen that may be useful.
  • Make a list of all the medicines , as well as any vitamins or supplements that you take, including over-dose.
  • Keep a written record of your weight and give that record to your care provider to look for trends.
  • Make a list of the salt from the foods you eat regularly. Mention that if you have eaten more of these recently.
  • Ask a family member or friend to come, if possible, to help you remember the information they give you.
  • Write questions to ask your care provider.

For the pulmonary edema, some questions are:

  • What is the most likely cause of my symptoms?
  • What tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • What types of side effects can I expect from treatment?
  • There are alternatives to the treatment you are suggesting?
  • What is my prognosis?
  • No dietary or activity restrictions that must be followed? Could you help me to see a dietitian?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask a series of questions, including:

  • The symptoms been continuous?
  • How severe are the symptoms? The symptoms affected their work or daily activities?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Have you been diagnosed with obstructive sleep apnea or have symptoms of obstructive sleep apnea?
  • Do you have any family history of lung cancer or heart disease?
  • Have you ever been diagnosed with chronic obstructive pulmonary disease (COPD) or asthma?
  • Do you smoke or smoked in the past? If so, how many packs a day and when did you quit smoking?
  • Do you travel to higher altitudes to 1 mile?
Symptoms and treatment of Pulmonary edema