Acute pulmonary edema is a life-threatening condition that can occur suddenly and at any time during a cardiac catheterization procedure. It is also commonly referred to as “flash” pulmonary edema. The cath lab team must recognize the symptoms, diagnose the cause, and treat the condition in a rapid fashion to stabilize the patient. Pulmonary means lungs and edema means swelling. It is a condition which is caused by excess fluid accumulation. This fluid collects in the numerous air sacs in the lungs, which makes difficult to breathe. In most of the cases, heart problems are caused due to pulmonary edema.
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Pulmonary edema can be acute (sudden onset) or chronic (occurring more slowly over time). If it is acute, it is classed as a medical emergency needing immediate attention.
The most common cause of pulmonary edema is congestive heart failure, where the heart cannot keep up with the demands of the body.
Treatment of pulmonary edema usually focuses on improving respiratory function and dealing with the source of the problem. It generally includes providing additional oxygen and medications to treat the underlying conditions.
Fast facts on pulmonary edema
- Pulmonary edema is a condition involving fluid buildup in the lungs.
- Sudden onset (acute) pulmonary edema is a medical emergency.
- Symptoms include shortness of breath, cough, decreased exercise tolerance or chest pain.
Treatment
To raise the patient's blood oxygen levels, oxygen is given either through a face mask or prongs - tiny plastic tubes in the nose. A breathing tube may be placed into the trachea if a ventilator, or breathing machine, is necessary.
If tests show that the pulmonary edema is because of a problem in the circulatory system, the patient will be treated with intravenous medications to help remove fluid volume and control blood pressure.
Causes
During normal breathing, the small air sacs in the lungs - alveoli - fill up with air. Oxygen is taken in, and carbon dioxide is expelled. Pulmonary edema occurs when the alveoli are flooded.
When the alveoli are flooded, two problems occur:
- The bloodstream cannot get enough oxygen.
- The body is unable to get rid of carbon dioxide properly.
Common causes include:
- sepsis (blood infection)
- exposure to some chemicals
- organ failure that causes fluid accumulation - congestive heart failure, kidney failure, or liver cirrhosis
- near-drowning
- trauma
- reaction to certain medications
Besides direct injury to the lungs, as in ARDS, other causes include:
- brain injuries such as brain bleeding, stroke, head injury, brain surgery, tumor, or seizure
- blood transfusion
Cardiogenic pulmonary edema
Pulmonary edema that is due to a direct problem with the heart is called cardiogenic.
Congestive heart failure is a common cause of cardiogenic pulmonary edema; in this condition, the left ventricle cannot pump out enough blood to meet the needs of the body.
This causes a buildup of pressure in other parts of the circulatory system, forcing fluid into the air sacs of the lungs and other parts of the body.
Other heart-related problems that can lead to pulmonary edema include:
- Fluid overload - this can result from kidney failure or intravenous fluid therapy.
- Hypertensive emergency - a severe increase in blood pressure that puts excessive strain on the heart.
- Pericardial effusion with tamponade - a buildup of fluid around the sac that covers the heart. This can decrease the heart's ability to pump.
- Severe arrhythmias - this can be tachycardia (fast heartbeat) or bradycardia (slow heartbeat). Either can result in poor heart function.
- Severe heart attack - this can damage the muscle of the heart, making pumping difficult.
- Abnormal heart valve - can affect the flow of blood out of the heart.
Causes of pulmonary edema that are not due to poor heart function are called noncardiogenic; they are typically caused by ARDS (acute respiratory distress syndrome). This is a severe inflammation of the lungs that leads to pulmonary edema and significant breathing difficulties.
Symptoms
Acute pulmonary edema causes significant breathing difficulties and can appear without warning. This is an emergency and requires immediate medical attention. Without proper treatment and support, it can be fatal.
Along with breathing difficulties, other signs and symptoms of acute pulmonary edema can include:
- cough, often with a pink frothy sputum
- anxiety and restlessness
- feelings of suffocation
- pale skin
- wheezing
- rapid or irregular heart rhythm (palpitations)
- chest pain
If the pulmonary edema is chronic, symptoms are normally less severe until the body's system can no longer compensate. Typical symptoms include:
- difficulty breathing when lying flat (orthopnea)
- swelling (edema) of feet or legs
- rapid weight gain due to the accumulation of excess fluid
- paroxysmal nocturnal dyspnea - episodes of severe sudden breathlessness at night
- increased breathlessness with physical activity
Pulmonary edema or plural effusion
Pulmonary edema happens when fluid collects inside the lungs, in the alveoli, making it hard to breathe. Plural effusion also involves fluid in the lung area, and it is sometimes called 'water on the lungs.'
However, in pleural effusion, water fluid collects in the layers of the pleura that are ouside the lungs. It can result from heart failure, cirrhosis, or a pulmonary embolism. It can also occur after heart surgery.
Pulmonary edema or pneumonia
Pulmonary edema can overlap with pneumonia, but it is a different condition. Pneumonia is an infection that often occurs as a complication of a respiratory infection, such as the flu.
It can be difficult to distinguish between the two. If the individual or a family member can provide a detailed medical history, this will make it easier for a physician to make the correct diagnosis and provide the right treatment.
Diagnosis
Sometimes, a chest X-ray can assist in the diagnosis of pulmonary edema.
The patient will undergo a physical exam first. The doctor will use a stethoscope to listen to the lungs for crackles and rapid breathing, and the heart for abnormal rhythms.
Blood tests will be carried out to determine blood oxygen levels; the doctor will often order other blood tests, including:
- electrolyte levels
- kidney function
- liver function
- blood counts and blood markers of heart failure
An ultrasound of the heart, an echocardiogram, and an electrocardiogram (EKG) can help determine the condition of the heart.
A chest X-ray may be used to see whether there is any fluid in or around the lungs and to check the size of the heart. A CT scan of the chest may also be ordered.
Prevention
Patients with an increased risk of developing pulmonary edema must follow their doctor's advice to keep their condition under control.
If congestive heart failure is the problem, following a healthy, well-balanced diet, and maintaining a healthy body weight can help reduce the risk of future episodes of pulmonary edema.
Regular exercise also improves heart health as does:
- Reducing salt intake - excess salt can lead to water retention. This increases the work the heart has to do.
- Lowering cholesterol levels - high cholesterol can lead to fatty deposits in the arteries, which, in turn, increases the risk of heart attack and stroke and therefore pulmonary edema.
- Smoking cessation - tobacco increases the risk of a number of diseases, including heart disease, lung disease, and circulatory problems.
Altitude-induced pulmonary edema can be minimized by making a gradual ascent, taking medications before traveling, and avoiding excess exertion while progressing to higher altitudes.
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Cardiovascular / CardiologyHeart Disease
Article last updated by Yvette Brazier on Mon 18 December 2017.
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Pulmonary edema is a condition in which the lungs fill with fluid. It’s also known as lung congestion, lung water, and pulmonary congestion. When pulmonary edema occurs, the body struggles to get enough oxygen and you start to have shortness of breath.
But timely treatment for pulmonary edema and its underlying cause can improve possible outcomes.
There are several possible causes of pulmonary edema.
Congestive heart failure
The most common cause of pulmonary edema is congestive heart failure (CHF). Heart failure happens when the heart can no longer pump blood properly throughout the body. This creates a backup of pressure in the small blood vessels of the lungs, which causes the vessels to leak fluid.
In a healthy body, the lungs will take oxygen from the air you breathe and put it into the bloodstream. But when fluid fills your lungs, they cannot put oxygen into the bloodstream. This deprives the rest of the body of oxygen.
Other medical conditions
Other less common medical conditions that can cause pulmonary edema include:
Pulmonary Edema Radiology
- heart attack, or other heart diseases
- leaking, narrowed, or damaged heart valves
- sudden high blood pressure
- lung damage caused by severe infection
- severe sepsis of the blood, or blood poisoning caused by infection
External factors
Some external factors can also put extra pressure on the heart and lungs and cause pulmonary edema. These outside factors are:
- high altitude exposure
- illicit drug use or drug overdose
- lung damage caused by inhalation of toxins
- severe trauma
- major injury
In cases of pulmonary edema, your body will struggle to gain oxygen. This is due to the amount of increasing fluid in the lungs preventing oxygen moving into the bloodstream. Symptoms may continue to worsen until you get treatment.
Symptoms depend on the type of pulmonary edema.
Long-term pulmonary edema
The symptoms for long-term pulmonary edema include:
- shortness of breath when being physically active
- difficulty breathing when lying down
- waking up at night with a breathless feeling that goes away when you sit up
- rapid weight gain, especially in the legs
![Pulmonary Edema Pdf Pulmonary Edema Pdf](/uploads/1/2/4/9/124906326/213566487.png)
High-altitude pulmonary edema
Pulmonary edema due to altitude sickness, or not getting enough oxygen in the air, will have symptoms that include:
- irregular, rapid heartbeat
- difficulty walking uphill and on flat surfaces
Get emergency assistance if these symptoms start to get worse. Do not drive yourself to the hospital.
You doctor will look for fluid in your lungs, or symptoms caused by its presence. They will perform a basic physical examination and listen to your lungs with a stethoscope, looking for:
- an increased heart rate
- rapid breathing
- a crackling sound from your lungs
- any abnormal heart sounds
Your doctor may also look at your neck for fluid buildup, legs and abdomen for swelling, and if you have pale or blue-colored skin. They will also discuss your symptoms, and ask about your medical history. If they believe you have fluid in your lungs, they’ll order additional tests.
Examples of tests used in diagnosing pulmonary edema include:
- echocardiogram, or an ultrasound, to check for abnormal heart activity
- chest X-ray to see fluid
- blood tests to check oxygen levels
- electrocardiogram (ECG) to look for heart rhythm problems or signs of a heart attack
Pulmonary edema is a serious condition that requires quick treatment. Oxygen is always the first line of treatment for this condition. Your healthcare team may prop you up and deliver 100 percent oxygen through an oxygen mask, nasal cannula, or positive pressure mask.
Your doctor will also diagnose the cause of pulmonary edema and prescribe the appropriate treatment for the underlying cause.
Depending on your condition and the cause of your pulmonary edema, your doctor may also give:
- Preload reducers. These help decrease pressures from the fluid going into your heart and lungs. Diuretics also help reduce this pressure by making you urinate, which eliminates fluid.
- Afterload reducers. These medications dilate your blood vessels and take pressure off your heart.
- Heart medications. These will control your pulse, reduce high blood pressure, and relieve pressure in arteries and veins.
- Morphine. This narcotic is used to relieve anxiety and shortness of breath. But fewer doctors today use morphine due to the risks.
In severe cases, people with pulmonary edema may need intensive or critical care.
In other cases of pulmonary edema, you may need treatment to help you breathe. A machine will deliver oxygen under pressure to help get more air into your lungs. Sometimes this can be done with a mask or cannula, also called Continuous Positive Airway Pressure (CPAP).
Your doctor may need to insert an endotracheal tube, or breathing tube, down your throat and use mechanical ventilation.
Sometimes pulmonary edema is confused with pleural effusion, another condition that involves fluid buildup in the lungs. However, pleural effusion specifically causes a buildup of fluids in the pleural tissues. These cover the outside of each of your lungs as well as the inside of the chest wall.
Pulmonary Edema
Pleural effusion can be caused by CHF, poor nutrition, and pneumonia. It’s also sometimes cancerous (malignant).
With pleural effusion, you may experience:
- breathing difficulties
- a dry cough
- shortness of breath
- chest pain and discomfort
A chest x-ray can help diagnose pleural effusion. Your doctor may take a biopsy from pleural tissues if cancer is suspected. Depending on the cause, pleural effusion may be treated with a combination of fluid removal techniques and surgery.
Pneumonia is another serious condition of the lungs. Unlike edema, pneumonia is caused by either a viral, fungal, or bacterial infection. As your lungs become infected, fluid builds up in the air sacs (alveoli).
While both pulmonary edema and pneumonia cause a form of buildup in the lungs, the former is primarily caused by CHF. Pneumonia, on the other hand, is caused by an infection. A weakened immune system can increase your chances of getting pneumonia from a common cold or flu.
Symptoms of pneumonia may include:
- high fever with chills
- cough with mucus that continues to worsen
- chest pain and discomfort
- shortness of breath
- nausea and/or vomiting
- diarrhea
Pneumonia is one of the most common causes of hospitalization in children and adults, according to the American Lung Association. When left untreated, this condition can lead to:
- pleural effusion
- septic shock
Pulmonary edema isn’t a cause of pneumonia. However, the buildup of fluids from pneumonia can lead to pleural effusion. Pneumonia requires immediate treatment to prevent complications, which may require antibiotics and oxygen therapy.
Call 911 or local emergency services immediately for medical help if you experience any of these symptoms:
- extreme breathing difficulties, or shortness of breath, like suffocating or drowning
- inability to breathe
- anxiety related to trouble breathing
- cough that produces a pink, frothy mix of saliva and mucus
- chest pain
- rapid, irregular heartbeat
- blue or gray skin tone
- sweating along with breathing difficulties
These may be symptoms of acute pulmonary edema. Acute pulmonary edema develops suddenly. If left untreated, the fluid in your lungs can cause you to drown.
People with heart problems or heart failure are the most at risk for pulmonary edema. Other factors that may put a person at risk include:
- history of pulmonary edema
- history of lung disease, such as tuberculosis or chronic obstructive pulmonary disorder (COPD)
- vascular (blood) disorders
There is no way to fully prevent pulmonary edema. Those at high risk should seek immediate attention if they develop symptoms of the disorder.
The best way to try and prevent pulmonary edema is by taking good care of your health:
- Get a pneumonia vaccine.
- Get the flu vaccine, especially if you have heart problems or if you are an older adult.
- Remain on diuretics after an episode of pulmonary edema to prevent a reoccurrence.
You can also decrease your risk for heart failure, the most common cause of pulmonary edema with the following steps:
- Visit your doctor regularly.
- Don’t smoke or use recreational drugs.
- Get regular exercise.
- Eat healthy foods.
- Maintain a normal weight.
The outlook for pulmonary edema depends on the severity of your case. If you have a moderate case and receive quick treatment, you will often have a full recovery. Severe cases can be fatal if you delay treatment.
Be sure to see your doctor regularly, and get immediate help if you experience any of the symptoms of pulmonary edema.