Pulmonary Edema

 

Pulmonary Edema

Pulmonary Edema

Pulmonary edema is a buildup of fluid in your lungs. A main cause of pulmonary edema is congestive heart failure. It can occur due to non-heart-related conditions, too. Symptoms include shortness of breath and difficulty breathing. Sudden (acute) pulmonary edema requires immediate treatment. Pulmonary edema can also develop over time (chronic)

 

What is pulmonary edema?

Pulmonary edema is the abnormal buildup of “fluid in the lungs.” Fluid buildup in your lungs can lead to shortness of breath, coughing up of foam and loose mucus, wheezing, chest tightness and difficulty breathing. Pulmonary edema can be life-threatening and requires immediate medical treatment.

What is high altitude pulmonary edema (HAPE)?

High altitude pulmonary edema (HAPE) occurs when you’re at high altitudes or if you’re rapidly going up (ascending) a mountain. HAPE is a severe form of altitude sickness (also known as mountain sickness), which occurs because oxygen levels are lower at higher altitudes.

HAPE can make you tired, weak, achy and short of breath. It can cause coughing and chest tightness. HAPE is a medical emergency and can be life-threatening. If you have HAPE, you need to go down (descend) immediately and receive medical treatment.

What’s the difference between pulmonary edema and pneumonia?

Both pulmonary edema and pneumonia involve a buildup of fluid in your lungs. An infection causes pneumonia. The infection can be viral, bacterial or fungal. These organisms can cause infected fluid to fill your air sacs. An infection doesn’t cause pulmonary edema, and the fluid is typically thinner and watery.

What’s the difference between pulmonary edema and pleural effusion?

Pleural effusion is when abnormal amounts of fluid buildup outside of your lungs in the pleura, which is a lining around your lungs. The pleura sits between your lungs and the inside of your chest wall, and usually only has a thin rim of fluid inside it. Pleural effusion is commonly caused by pneumonia, congestive heart failure or cancer. Unlike pulmonary edema, the fluid sits outside of your lungs and can compress your lungs, which are spongy.

What is swimming-induced pulmonary edema?

Immersion pulmonary edema is sometimes called swimming-induced pulmonary edema. It occurs when competitive swimmers and divers develop lung injuries because their lung capillaries burst. During diving, blood is sent to your lungs from your legs and abdomen. That excess blood increases pressure in the blood vessels of your lungs. The vessels leak, and the fluid goes into your air sacs.

SYMPTOMS AND CAUSES

What causes pulmonary edema?

The causes of pulmonary edema can be broken down into two groups: cardiogenic (heart-related) or noncardiogenic (not heart-related).

Cardiogenic

Cardiogenic pulmonary edema means fluid backs up in your lungs from a heart problem. The most common cause of cardiogenic pulmonary edema is congestive heart failure. When the left side of your heart stops pumping blood correctly, the blood backs up into the blood vessels in your lungs. As the pressure in your blood vessels increases, fluid is pushed into the air sacs in your lungs.

Congestive heart failure that leads to pulmonary edema can be from:

• Heart attack.
• Weakened heart muscles (cardiomyopathy).
• Heart valves that are leaky or narrowed (valvular heart disease).
• High blood pressure (hypertension).
• Abnormal heart rhythm (arrhythmia).
• Inflammation of your heart muscle (myocarditis).
• Fluid in the pericardium, a lining around your heart (pericardial effusion).

Noncardiogenic

Noncardiogenic pulmonary edema occurs when other diseases cause fluid to accumulate in your lungs. It isn’t caused by increased blood flow in your lungs due to a backup from heart problems. Instead, the blood vessels in your lungs become inflamed or injured. The blood vessels then become leaky, and fluid goes into your air sacs.

Adult respiratory distress syndrome (ARDS) is another common name for noncardiogenic pulmonary edema. In ARDS, inflammation is the main problem, with causes that include:

• Pneumonia.
• Sepsis (severe infection).
• Trauma.
• Pancreatitis.
• Liver disease.
• Drugs.
• Bleeding or swelling in your brain (neurogenic pulmonary edema).

Negative pressure pulmonary edema can occur after a blockage in your upper airway. Straining to breathe when this obstruction happens causes injury to your pulmonary blood vessels, and they leak into your air sacs. In high altitude pulmonary edema (HAPE), your pulmonary blood vessels constrict and become leaky.

What are the signs and symptoms of pulmonary edema?

Pulmonary edema can come on suddenly (acute) or develop as a long-term (chronic) condition.

Sudden (acute) pulmonary edema

Signs and symptoms of sudden pulmonary edema include:

• Shortness of breath (dyspnea), especially during movement or lying down.
• Coughing up blood or frothy mucus.
• Wheezing.
• Gasping for air.
• Feeling like you’re suffocating.
• Chest tightness or pain.

Long-term (chronic) pulmonary edema

The signs and symptoms of long-term pulmonary edema include the same symptoms as sudden pulmonary edema, although the symptoms may be milder. Other symptoms of long-term pulmonary edema include:

• Feeling of breathlessness that awakens you.
• Shortness of breath when lying flat.
• Swelling in your legs.
• Tiredness.

DIAGNOSIS AND TESTS

How is pulmonary edema diagnosed?

A healthcare provider will perform a physical exam to see if you have fluid in your lungs. They’ll listen to your heart and lungs with a stethoscope. They’ll be examining you for:

• Increased or decreased heart rate or blood pressure.
• Increased respiratory rate.
• Abnormal heart sounds.
• Crackling sounds or wheezing/whistling sounds in your lungs.
• Swelling of your body.
• Gray or bluish skin.

What tests will be done to diagnose pulmonary edema?

If your healthcare provider thinks you may have fluid in your lungs, they’ll order additional tests, including:

• Complete blood count (CBC).
• Blood chemistries.
• Pulse oximetry, to check your blood oxygen levels.
• Chest X-ray, to see if there’s fluid in your lungs.
• Echocardiogram, an ultrasound of your heart to check for abnormal heart activity.
• Electrocardiogram (EKG), to check for heart rhythm problems or a heart attack.
• Cardiac catheterization, to check for blockages in your coronary arteries.

MANAGEMENT AND TREATMENT

How is pulmonary edema treated?

Pulmonary edema is a serious condition. If you have sudden (acute) pulmonary edema, you need immediate treatment. You may need to be treated in the emergency room (ER) or intensive care unit (ICU).

Some treatment options include:

• Oxygen delivered through prongs in your nose.
• Machines that blow air into your lungs through a mask on your face.
• Ventilators or respirators that blow in air through a tube inserted into your windpipe.
• Medications that cause you to urinate more and get rid of fluid or which strengthen your heart.
• Other medications, when congestive heart failure isn’t the cause of your pulmonary edema, such as antibiotics and steroids.

PREVENTION

How can I prevent pulmonary edema?

If you’re at a higher risk of pulmonary edema, you can take steps to take care of yourself. These steps include:

• Take medications as directed if you have a heart condition.
• Get routine vaccinations.
• See your healthcare provider regularly and if you have problems breathing.
• Eat a healthy diet low in salt.
• Don’t smoke.
• Maintain a healthy weight.
• Talk to your provider if you’re planning activities (such as mountain climbing) that can cause pulmonary edema.

 

References

• Iqbal MA, Gupta M. Cardiogenic Pulmonary Edema. (https://www.ncbi.nlm.nih.gov/books/NBK544260/) [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 9/16/2022.
• Merck Manual. Multiple pages reviewed. (https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/pulmonary-edema) Accessed 9/16/2022.
• U.S. National Library of Medicine. Pulmonary edema. (https://medlineplus.gov/ency/article/000140.htm) Accessed 9/16/2022.