Table of Contents
Definition of Pulmonary Edema
Pulmonary Edema is Abnormal fluid accumulation within the alveoli and the interstitial tissues of the LUNGS, typically resulting from CARDIOVASCULAR DISEASE (CVD)such as HEART FAILURE or CARDIOMYOPATHY. PNEUMONIA, ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), smoke inhalation, near drowning, and high altitude can also cause pulmonary edema.
Pulmonary edema can be a life-threatening condition and requires immediate medical evaluation and treatment.
The accumulated fluid of pulmonary edema limits air from entering the alveoli, affecting the OXYGEN-CARBON DIOXIDE EXCHANGE. The consequence is inadequate oxygen diffusion into the BLOODwith resulting HYPOXIA.
Symptoms and Diagnostic Path
The symptoms of pulmonary edema tend to come on quickly and include
- DYSPNEA (difficulty BREATHING), often severe or worse when lying down
- frothy HEMOPTYSIS (coughing up bloody SPUTUM)
- diaphoresis (profuse sweating or chills with sweating)
- HEADACHE or light-headedness
- Wheezing or gurgling sounds when breathing
Respiratory failure can rapidly develop. The diagnostic path includes AUSCULTATION with a stethoscope to listen to BREATH SOUNDS, which typically reveals rales (crackles). A chest X-RAY shows the accumulated fluid. Arterial blood gases assess the extent of hypoxia. Diagnostic procedures to evaluate cardiovascular function include ELECTROCARDIOGRAM (ECG), ECHOCARDIOGRAM, and CARDIAC CATHETERIZATION if the doctor suspects CORONARY ARTERY DISEASE (CAD) or MYOCARDIAL INFARCTION.
Treatment Options and Outlook
Treatment begins with OXYGEN THERAPY to improve oxygenation and, if the edema is from heart failure, usually diuretic medications to help pull the excessive fluid into the circulation so the KIDNEYS can pass it from the body. Additional treatment targets the underlying cause of the pulmonary edema, which may be cardiovascular or pulmonary. High altitude pulmonary edema (HAPE) requires prompt oxygen therapy with descent to a lower altitude as soon as is feasible. Climbers sometimes underestimate the seriousness of HAPE until symptoms become overwhelming and lifethreatening. Any climber, regardless of high-altitude acclimation and climbing experience, is vulnerable to HAPE and all climbers should be familiar with early symptoms.
Pulmonary edema is a serious circumstance that can result in death when not promptly recognized and treated. The underlying cause determines the outcome. When the cause is cardiovascular, treatment may include CORONARY ARTERY BYPASS GRAFT (CABG) or ANGIOPLASTY to improve the flow of blood to the HEART. Medications may strengthen the heart and stabilize HEART RATE in heart failure, improving the heart’s ability to pump blood. With appropriate treatment, many people recover completely from pulmonary edema. When the cause is noncardiogenic, such as due to severe infection or ARDS, treatment targets reversing the underlying disease and providing respiratory support until lung function returns to normal.
Risk Factors and Preventive Measures
The primary risk factor for cardiogenic pulmonary edema is cardiovascular disease. The most effective preventive measures are those that reduce the risks for cardiovascular disease: No smoking, maintain appropriate weight, exercise daily, and eat nutritiously. It is also important to take medications for diagnosed conditions such as HYPERTENSION (high BLOOD PRESSURE) as prescribed.