Pulmonary edema: causes, symptoms and treatment

Pulmonary edema is a condition caused by excess fluid in the lungs. Fluid builds up in the many air sacs of the lungs and makes it difficult to breathe.

In most cases, heart problems cause pulmonary edema. However, fluid can build up in the lungs for other reasons. These include pneumonia, contact with certain toxins, medications, chest wall trauma, and travel or exercise at high altitudes.

Pulmonary edema that occurs suddenly (acute pulmonary edema) is a medical emergency that requires immediate medical attention. On some occasions, pulmonary edema can lead to death. Immediate treatment might help. Treatment for pulmonary edema depends on the cause, but usually includes supplemental oxygen and medication.

Symptoms of pulmonary edema can come on suddenly or develop over time. Symptoms depend on the type of pulmonary edema.

Difficulty breathing (dyspnea) or excessive shortness of breath that gets worse with activity or lying down Feeling of choking or choking that gets worse when you lie down Frothy sputum that may contain blood Rapid, irregular heartbeat (palpitations ) Anxiety, restlessness, or a feeling that something bad is about to happen Cold, clammy skin Wheezing or shortness of breath

Waking up at night with a cough or shortness of breath that can be relieved by sitting up Shortness of breath when being active or lying down Tiredness More shortness of breath than usual when you are active New or worsening cough Rapid weight gain Swelling of the legs and feet Wheezing in the chest

Adults and children who travel or exercise at high altitudes may suffer high altitude pulmonary edema . Symptoms are similar to those of acute pulmonary edema and may include the following:

Headaches, which may be the first symptom. Shortness of breath when performing activities, which becomes shortness of breath during rest. Inability to exercise as much as before. Dry cough, at first. Subsequently, a cough that produces frothy sputum that may be pink or bloody. Very fast heartbeat (tachycardia). Weakness Chest pain Fever.

Symptoms of high altitude pulmonary edema tend to get worse at night.

Pulmonary edema that occurs suddenly (acute pulmonary oedema) can be fatal. Dial 911 or call emergency medical help if you experience any of the following acute symptoms:

Shortness of breath, especially if it happens suddenly Difficulty breathing or a feeling of choking (dyspnea) Gurgling, wheezing, or gasping when you breathe Pink or bloody sputum Difficulty breathing accompanied by heavy sweating Blue tint or gray skin Disorientation A severe fall high blood pressure causing dizziness, lightheadedness, weakness, or sweating Sudden worsening of any of the symptoms associated with pulmonary edema

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

Heart failure and other heart conditions that increase pressure on the heart increase the risk of pulmonary edema. Here are the risk factors for heart failure:

Irregular heartbeat (arrhythmias) Alcohol use Congenital heart disease Coronary artery disease Diabetes Heart valve disease High blood pressure Sleep apnea

Certain nervous system conditions and lung damage from near-drowning, illicit drug use, smoke inhalation, viral infections, and blood clots also increase the risk.

People who travel to places above 8,000 feet (about 2,400 meters) are more likely to develop pulmonary edema at high altitudes. It generally affects people who do not take the time (from a few days to a week or more) to get used to the altitude.

Children who already have pulmonary hypertension and structural heart defects are more likely to develop high altitude pulmonary edema .

Respiratory problems should be diagnosed and treated immediately. Your healthcare provider may base your diagnosis of pulmonary edema on your symptoms and the results of a physical exam and certain tests.

Once stabilized, the health care provider may ask you about your medical history, especially a history of pulmonary or cardiovascular disease.

Here are some of the tests that help diagnose pulmonary edema or determine the reason for fluid in the lungs:

Pulmonary radiography.

A chest X-ray can confirm the diagnosis of pulmonary edema and rule out other possible causes of shortness of breath. When a health care provider suspects the patient has pulmonary edema, this is usually the first test that is done.

Chest computed tomography.

There

computed tomography

A chest CT scan provides more details about the condition of the lungs. This can help the healthcare provider diagnose or rule out pulmonary edema.

Pulse oximetry.

A sensor is attached to a finger or an ear. It uses light 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.

Analysis of B-type natriuretic peptide in blood.

The increase in the level of

B-type natriuretic peptide

this can be an indication of heart disease.

Other blood tests.

Blood tests to diagnose pulmonary edema and its causes typically include: a complete blood count, metabolic panel to check kidney function, and thyroid function tests.

Electrocardiogram (ECG).

This painless test detects and records the rhythm and intensity of heart signals. It uses small sensors (electrodes) that are attached to the chest and sometimes to the arms or legs. The cables allow the sensors to be connected to a machine which displays and prints the results. A

electrocardiogram

he may show signs of thickening of the heart walls or of a heart attack. A portable device can be used to make

electrocardiograms

like a Holter monitor, to continuously monitor your heart rate from home.

Echocardiogram.

An echocardiogram uses sound waves (ultrasound) to create images of the heart as it beats. It can identify areas of poor blood circulation, heart valve problems, and heart muscle that is not working properly. An echocardiogram can help diagnose fluid around the heart (pericardial effusion).

Cardiac catheterization and coronary angiography.

This test may be done if other tests do not indicate a cause of pulmonary edema or if you also have chest pain. Helps healthcare providers detect blockages in heart arteries. A long, flexible tube (catheter) is inserted into a blood vessel, usually in the groin or the wrist, and guided to the heart. A dye flows through the catheter into the arteries of the heart. Contrast material helps arteries show up more clearly on x-ray and video images.

Ultrasound of the lungs.

This test is painless and uses sound waves to measure blood flow in the lungs. He may quickly show signs of fluid accumulation and pleural effusions.

The first treatment for acute pulmonary edema is to provide oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal hooks) that deliver oxygen to each nostril. This should alleviate some symptoms.

A health care provider checks the oxygen level. Sometimes respiratory support using equipment such as a mechanical respirator or equipment that provides positive airway pressure may be necessary.

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

Diuretics.

Diuretics, such as furosemide (Lasix), lower the pressure caused by excess fluid in the heart and lungs.

Medicines for blood pressure.

These help manage high or low blood pressure, which can occur when you have pulmonary edema. Your health care provider may also prescribe medications that reduce pressure on your heart. Some examples of these drugs are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).

Inotropes.

This type of medication is given intravenously to hospitalized people with severe heart failure. Inotropes improve the pumping function of the heart and maintain blood pressure.

Morphine (MS Contin, Infumorph, others).

This narcotic can be taken orally or intravenously to relieve shortness of breath and anxiety. However, some healthcare providers believe the risks of morphine may outweigh the benefits. They are more likely to use other medications.

It is important to diagnose and treat, if possible, any nervous system problems or causes of heart failure.

Oxygen is usually the first treatment. If oxygen is not available, a portable hyperbaric chamber can mimic descent to a lower altitude until travel to a higher altitude is possible.

Here are some treatments for high altitude pulmonary edema:

Descend immediately to a lower altitude.

For a person who is at high altitude and has mild symptoms of

high altitude pulmonary edema

, descending between 1,000 and 3,000 feet (about 300 to 1,000 meters) as fast as possible can help. a person with

high altitude pulmonary edema

severe conditions may require rescue to descend the mountain.

Stop exercising and continue

body heat.

Pulmonary edema can worsen with physical activity and cold.

Medications.

Some climbers take prescription medication, such as acetazolamide or nifedipine (Procardia), to help treat or prevent symptoms of

high altitude pulmonary edema

. To prevent the

high altitude pulmonary edema

they start taking the drug at least a day before they continue to climb.