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Pulmonary edema

Definition


Disease: Pulmonary edema Pulmonary edema
Category: Respiratory diseases
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Disease Definition:

When too much fluid accumulates in numerous air sacs in the lungs pulmonary edema outcomes, and breathing might become quite tough. Heart problems mostly are the reason behind pulmonary edema’s occurrence, but there might be other causes as well, such as pneumonia, exercising or living at high elevations and exposure to some toxins and medications.
Prompt care might be needed for pulmonary edema that abruptly takes place (acute) for being a medical emergency condition. In the case of getting an immediate effective treatment for pulmonary edema along with treatment for the underlying cause, the outcomes might be promising, even though this condition could occasionally prove to be fatal. Depending on the reason underlying pulmonary edema, treatment might be determined, but generally supplemental oxygen and medications might be included.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Pulmonary edema symptoms might be apparent abruptly or gradually grow, depending on the reason behind its occurrence.

The followings include signs and symptoms that might abruptly be apparent:

  • A feeling of suffocating or drowning
  • Pale skin
  • Extreme shortness of breath or tough time breathing
  • A quick, irregular heartbeat (palpitations)
  • Wheezing or gasping for breath
  • Chest pain, in case pulmonary edema is the outcome of a heart disease
  • Anxiety, restlessness or a sense of apprehension
  • A cough producing frothy sputum that might be tinged with blood
  • Excessive sweating


When signs and symptoms are apparent, seeking immediate emergency care might be wise, for pulmonary edema in case left untreated it might be a fatal condition.

The followings are signs and symptoms that grow more slowly, usually because of heart failure:

  • Difficulty breathing with exertion, often when you're lying flat as opposed to sitting up.
  • Loss of appetite.
  • Having more shortness of breath than normal when you're physically active.
  • Fatigue.
  • Rapid weight gain when pulmonary edema develops as a result of congestive heart failure, a condition in which your heart pumps too little blood to meet your body's needs. The weight gain is from accumulation of fluid in your body, especially in your legs.
  • Awakening at night with a breathless feeling that might be relieved by sitting up.

The followings are signs and symptoms of pulmonary edema resulting from high-altitude:

  • Cough.
  • Headache.
  • Breathlessness.
  • Fluid retention.
  • Insomnia.


When pulmonary edema suddenly takes place (acute) it might be life-endangering. Emergency assistance might be required right away in case of experiencing the following acute signs and symptoms:

  • Pink, frothy sputum when coughing.
  • A severe drop in blood pressure.
  • Trouble breathing or a feeling of suffocating (dyspnea).
  • Any of the symptoms related to chronic pulmonary edema or high-altitude pulmonary edema to become suddenly worse.
  • A blue or gray tone to the skin.
  • Tough time breathing along with profuse sweating.
  • A bubbly, wheezing or gasping sound when breathing.


It isn’t wise to be driving on one’s own to hospital in order to get help; one should seek emergency medical care and wait for help.

Causes:

The lungs contain numerous small, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide. The exchange of gases occurs without problems under normal circumstances.
But in certain circumstances, the alveoli fill with fluid instead of air preventing oxygen from being absorbed into the bloodstream. Several things could cause fluid to accumulate in the lungs, but most have to do with the heart (cardiac pulmonary edema). Understanding the relationship between the heart and lungs could help explain why.

How the heart works
The heart is composed of two upper and two lower chambers. The upper chambers (the right and left atria) receive incoming blood and pump it into the lower chambers. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves that keep blood flowing in the correct direction, are gates at the chamber openings.
Deoxygenated blood from all over the body under natural circumstances, enters the right atrium and flows into the right ventricle, where it’s pumped through large blood vessels (pulmonary arteries) to the lungs. There, the blood releases carbon dioxide and picks up oxygen. Next, the oxygen-rich blood goes back to the left atrium through the pulmonary veins, flows through the mitral valve into the left ventricle, and eventually exits the heart through another large artery, the aorta. The aortic valve at the base of the aorta prevents blood from flowing backward into the heart. From the aorta, the blood travels to the rest of the body.

What goes wrong
Cardiac pulmonary edema, additionally called congestive heart failure takes place when the diseased or overworked left ventricle is unable to pump out sufficient blood it receives from the lungs. As an outcome, pressure increases in the left atrium, later on to be in pulmonary veins and capillaries, resulting in fluid to be pushed through the capillary walls into the air sacs.
Additionally, congestive heart failure could take place when the right ventricle is unable to overcome raised pressure in the pulmonary artery that often is caused by left heart failure, chronic lung disease or high blood pressure in the pulmonary artery (pulmonary hypertension).

The followings are medical conditions that could result in the left ventricle to weaken and finally fail:

  • Coronary artery disease. The arteries supplying blood to the heart with time could become narrow from fatty deposits (plaques). A heart attack takes place when a blood clot forming in one of these narrowed arteries, preventing blood from flowing and damaging the part of the heart muscle supplied by that artery. The outcome is that the damaged heart muscle could no longer pump as well as it should.

Even though the rest of the heart tries to compensate for this loss, it is either not capable of effectively perform or it is weakened by the excess workload. If the pumping action of the heart is weakened, blood backs up into the lungs, forcing fluid in the blood to pass through the capillary walls into the air sacs.

  • Cardiomyopathy. If there are other reasons behind a damaged heart muscle than blood flow problems, the condition is known as cardiomyopathy. It isn’t known why exactly this condition is taking place, even though it occasionally might be the outcome of a family history. Viral infections (myocarditis) is a less common reason for the occurrence of cardiomyopathy, in addition to alcohol abuse and the toxic effects of medications like heroin and certain kinds of chemotherapy.

The heart might be unable to respond to conditions that require it to work harder, because cardiomyopathy weakens the left ventricle (the heart’s main pump) such as a surge in blood pressure, a faster heartbeat with exertion or extra salt consumption that causes water retention or infections. In case the left ventricle is unable to deal with the demands placed on it, fluid backs up into the lungs.

  • Heart valve problems. The valves regulating blood flow in the left side of the heart, in mitral valve disease or aortic valve disease, either is not open wide enough (stenosis) or isn’t totally closed (insufficiency). This allows blood to flow backward through the valve. When the valves are narrowed, blood is unable to flow freely into the heart and pressure in the left ventricle builds up, resulting in the left ventricle to make more and more effort with each contraction. Additionally, the left ventricle elaborates to allow more blood flow, but this makes the left ventricle’s pumping action less efficient. The left ventricle finally thickens due to the great effort it’s making that adds up heavy stress on the coronary arteries.

The excess pressure reaches out into the left atrium to later on stretch to the pulmonary veins, resulting in fluid to build up in the lungs. Then again, when the mitral valve leaks, some blood is backwashed toward the lung every time the heart pumps. When the leakage grows abruptly, abrupt and severe pulmonary edema might take place.

  • High blood pressure (hypertension). The left ventricular muscle might thicken and coronary artery disease worsen in case high blood pressure is not promptly treated or managed.


Noncardiac pulmonary edema
Heart disease might not always be the underlying cause for pulmonary edema. Fluid might additionally leak from the capillaries in the lungs’ air sacs due to the capillaries themselves become more permeable or leaky, even without the accumulation of back pressure from the heart. In which case, the condition is called noncardiac pulmonary edema since the heart isn’t the source of the problem. The followings are certain aspects that result in noncardiac pulmonary edema:

  • Lung infections. These infections might cause pulmonary edema, like pneumonia, the edema takes place just in the part of the lung that is inflamed.
  • Exposure to certain toxins. Such as inhaled toxins as in chlorine or ammonia, as well as those that might circulate within one’s own body, for instance, in the case of inhaling some of the stomach contents when vomiting.
  • Kidney disease. If kidneys fail to remove waste properly, extra fluid could accumulate, resulting in pulmonary edema.
  • Smoke inhalation. Chemicals existing in smoke resulting from fire are capable of damaging the membrane between the air sacs and the capillaries, allowing fluid to enter the lungs.
  • Adverse drug reaction. Noncardiac pulmonary edema might result from various medications, ranging from illegal drugs like heroin and cocaine to legal ones as aspirin and chemotherapy medications.
  • Acute respiratory distress syndrome (ARDS). This serious disorder takes place when fluid and inflammatory white blood cells are suddenly accumulated in the lung. Several conditions could result in ARDS, such as severe injuries (trauma), systemic infection (sepsis), shock and pneumonia.
  • High altitudes. Mountain climbers and people living in or traveling to high-altitude locations run the risk of growing high-altitude pulmonary edema (HAPE). This condition that commonly takes place at heights above 8,000 feet (about 2,400 meters), could affect hikers or skiers beginning exercising at elevated altitudes without first becoming acclimated. But even those who have hiked or skied at high altitudes in the past aren’t immune.

HAPE appears to grow as the outcome of increased pressure from constriction of the pulmonary capillaries. Even though it isn’t known exactly what’s causing this condition. HAPE could turn out to be fatal in case it isn’t promptly taken care of.

Complications

Complications:

When pulmonary edema persists, it could increase pressure in the pulmonary artery until the right ventricle finally fails. The right ventricle has a much thinner wall of muscle than does the left side. The elevated pressure backs up into the right atrium and then into several different parts of the body, leading to the followings:

  • Abdominal swelling (ascites)
  • Congestion and swelling of the liver
  • Leg swelling (edema)
  • Fluid accumulation in the membranes surrounding the lungs (pleural effusion)
  •  

Acute pulmonary edema could become a fatal condition in case it isn’t promptly treated. Sometimes treatment might not be capable to stop the condition from becoming fatal.

Treatments:

The first step in the  treatment for pulmonary edema is giving oxygen. One often receives oxygen through a face mask or nasal cannula, a flexible plastic tube with two openings giving oxygen to each nostril. Certain symptoms should be relieved this way. Assisting breathing with a machine might be required occasionally.
The following medications might additionally be delivered according to one’s condition and the underlying cause of pulmonary edema:

  • Preload reducers. Nitroglycerin and diuretics including furosemide are commonly used to treat pulmonary edema. These medications dilate the veins in the lungs and elsewhere in the body that reduces fluid pressure traveling into the heart and lungs. Diuretics might contribute to urinate much more frequently than expected in the beginning to the extent of requiring a short-term urinary catheter while one’s in the hospital.
  • Morphine. Improving breathlessness and anxiety might be achieved with this narcotic. Though the risks of morphine are considered to be outweighing the benefits and being more apt to use other, more effective medications.
  • Afterload reducers. These medications dilate the peripheral vessels removing a pressure load off the left ventricle. Certain examples of afterload reducer medications such as nitroprusside, captopril  and enalapril.
  • Blood pressure medications. In order to manage elevated blood pressure when growing pulmonary, edema medications might be prescribed. Then again, in the case of a very low blood pressure, medications might be administered to raise the pressure.

Treating high-altitude pulmonary edema (HAPE)
When one’s climbing or traveling at high altitudes and going through mild symptoms of HAPE, descending a few thousand feet (about 600 to 900 meters) should improve symptoms, in addition to oxygen supply that might be beneficial. In more severe cases, an aid might be required in the descent. A helicopter rescue might be important for the most serious cases, since HAPE could be life-endangering
Certain climbers take the prescription medication acetazolamide  to aid treating or keeping symptoms of HAPE from being apparent. To prevent HAPE, acetazolamide is started as long as three days before ascent. Acetazolamide could sometimes have side effects, such as tingling or burning in the hands and feet, diarrhea, loss of appetite, hearing problems, nausea and confusion.

Prognosis:

Not available

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