What are the signs and symptoms of pulmonary edema?

• A cough that produces foamy sputum that may be tinged with blood
• A feeling of suffocating or drowning
• Acute shortness of breath or difficulty breathing
• Anxiety, agitation or a sense of apprehension
• Chest pain, if pulmonary edema is caused by heart disease
• Excessive sweating
• Gasping for breath, wheezing , breathlessness
• Pale skin
• Rapid, irregular heartbeat, palpitations

• Ankle edema or swelling of the legs.
• Difficulty in breathing with effort. This is more noticeable when lying flat as opposed to sitting up.
• Fatigue.
• Loss of appetite.
• Nocturia or frequent urination at night.
• Rapid weight gain. The weight gain is from accumulation of fluid in the body, especially in the legs. Pulmonary edema may develop as a result of congestive heart failure, a condition in which the heart pumps too little blood to meet the body's needs.
• Unusual shortness of breath during physical activity.
• Waking-up at night with a breathless feeling that may be relieved by sitting up.

• Cough
• Fluid retention
• Headache
• Insomnia
• Shortness of breath

• A bubbly, wheezing or gasping sound when breathing
• A severe drop in blood pressure
• Breathing difficulty along with excessive sweating
• Pink, frothy sputum when coughing. It is a classic sign of pulmonary edema
• Skin has a blue or gray tone
• Trouble breathing or a feeling of suffocating (dyspnea)
• Sudden worsening of any of the symptoms associated with chronic pulmonary edema or high-altitude pulmonary edema

What are the causes of pulmonary edema?

The heart

It is composed of two upper and two lower chambers. The upper chambers are called the right and left atria. They receive incoming blood and pump it into the lower chambers. The lower chambers, through the ventricles, pump blood out of the heart. The heart valves keep blood flowing in the right direction.

The heart and the lungs

Usually, deoxygenated blood from all over your body enters the right atrium and flows into the right ventricle, where it is pumped through large blood vessels to the lungs. There, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then returns to the left atrium through the pulmonary veins, flows through the mitral valve into the left ventricle, and finally leaves the heart through another large artery, the aorta. The aortic valve at the base of the aorta keeps the blood from flowing backward into your heart. From the aorta, the blood travels to the rest of the body.

Cardiac pulmonary edema

Cardiac pulmonary edema is also known as congestive heart failure. It occurs when the overworked left ventricle is not capable of pumping out enough of the blood it receives from the lungs. As a result, pressure increases inside the left atrium and then in the pulmonary veins and capillaries. This causes fluid to be pushed through the capillary walls into the air sacs.

Congestive heart failure can also occur when the right ventricle is unable to overcome the amplified pressure in the pulmonary artery. This usually results from left heart failure, chronic lung disease or high blood pressure in the pulmonary artery (pulmonary hypertension).

• Coronary artery disease. Over time, the arteries that supply blood to the heart can become narrow from fatty deposits. A heart attack occurs when a blood clot forms in one of these narrowed arteries. There is blocking of the blood flow. This damages the section of the heart muscle supplied by that artery. The result is that the damaged heart muscle can no longer pump as well as it is supposed to.
  
  The rest of the heart tries to compensate. However, it is unable function efficiently or it is weakened by the added workload. When the pumping action of the heart is damaged, blood backs up into the lungs. As a result, fluid is forced to pass through the capillary walls and into the air sacs.


• Cardiomyopathy. It is a condition where the heart muscle is damaged by causes other than blood flow problems. Frequently, cardiomyopathy has no known cause. Although it is sometimes genetically inherited. Less common causes include viral infections (myocarditis), alcohol abuse and the toxic effects of drugs such as heroin and some types of chemotherapy.
  
  Cardiomyopathy weakens the left ventricle which is the heart's main pump. The heart may not be able to respond to conditions that require it to work harder (surge in blood pressure, a faster heartbeat with exertion or excess salt consumption that causes water retention or infections..) When the left ventricle cannot carry on with the demands, fluid backs up into the lungs.


• Heart valve. In mitral valve disease or aortic valve disease, the valves that regulate blood flow in the left side of the heart either do not open wide enough or do not close completely. This allows blood to flow backward through the valve. This condition causes greater stress on the coronary arteries.
  
  The increased pressure extends into the left atrium and then to the pulmonary veins, causing fluid to accumulate in the lungs. If the mitral valve leaks, some blood is backwashed toward the lung every time the heart pumps. If the leakage develops rapidly, sudden and severe pulmonary edema may develop.


• High blood pressure (hypertension) . Untreated or uncontrolled high blood pressure causes a thickening of the left ventricular muscle. It worsens coronary artery disease.

• Lung infections. Such as pneumonia. The edema occurs only in the part of the lung that is irritated.


• Exposure to certain toxins. Inhaled toxins such as chlorine or ammonia.


• Kidney disease. When the kidneys cannot eliminate waste effectively, excess fluid can build up, causing pulmonary edema.


• Smoke inhalation. Smoke from a fire contains chemicals. They can damage the membrane between the air sacs and the capillaries, allowing fluid to enter the lungs.


• Adverse drug reaction. Many drugs, (illegal drugs, aspirin and chemotherapy drugs) are recognized to cause noncardiac pulmonary edema.


• Acute respiratory distress syndrome (ARDS) . This serious disorder occurs when the lungs suddenly fill with fluid and inflammatory white blood cells. Many conditions can cause ARDS, including severe injuries (trauma), systemic infection (sepsis), pneumonia and shock.


• High altitudes. High-altitude pulmonary edema (HAPE) typically occurs at elevations above 8,000 feet (about 2,400 meters). It can affect climbers, hikers or skiers who start exercising at higher altitudes without first becoming acclimated. Even people who have hiked or skied at high altitudes in the past are not immune.

Diagnosis of pulmonary edema

• X-ray. A chest X-ray will probably be the first test to confirm the diagnosis of pulmonary edema.


• Electrocardiography (ECG) . This noninvasive test can reveal a wide range of information about the heart. During an ECG, patches are attached to the patient´s skin and receive electrical impulses from the heart. These are recorded in the form of waves on graph paper or a monitor. The wave patterns show the heart rate and rhythm, and if areas of the heart show diminished blood flow.


• Echocardiography or diagnostic cardiac ultrasound exam. It is a noninvasive test. It uses high-frequency sound waves that are reflected from the tissues of the heart. The sound waves are then sent to a machine that uses them to compose images of the heart on a monitor.
  
  This test can help diagnose a number of heart problems, including valve problems, abnormal motions of the ventricular walls, fluid around the heart and congenital heart defects.


• Transesophageal echocardiography (TEE) . A soft, flexible tube with a special transducer tip is inserted through the mouth and into the esophagus. It allows a closer and more accurate picture of the heart and central pulmonary arteries. The patient is given a sedative. It might cause a sore throat for a few days after the procedure. There's a slight risk of perforation or bleeding from the esophagus.


• Pulmonary artery catheterization. If other tests fail to reveal the reason for pulmonary edema, this procedure measures the pressure in the lung capillaries. During this test, a small, balloon-tipped catheter is inserted through a vein in the leg or arm into a pulmonary artery.


• Cardiac catheterization. If the ECG or echocardiography fails to uncover the cause of the pulmonary edema, or if the patient has chest pain, heart catheterization with coronary angiogram may be suggested. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in the groin, neck or arm and threaded through the blood vessels to the heart. If dye is injected during the test, it is referred to as a coronary angiogram. During this procedure, corrective action such as opening a blocked artery can be taken, which may quickly improve the pumping action of the left ventricle. Cardiac catheterization can also be used to measure the pressure in the heart chambers, evaluate the heart valves, and look for causes of pulmonary edema.

What is the treatment for pulmonary edema?

• Preload reducers. Nitroglycerin and diuretics (such as furosemide (Lasix)) are commonly used to treat pulmonary edema. These medications dilate the veins in the lungs and elsewhere in the body. This decreases fluid pressure going into the heart and lungs. Diuretics initially induce frequent urination. A catheter might be temporarily needed while in the hospital.


• Morphine (Astramorph, Roxanol) . This narcotic may be used to relieve shortness of breath and anxiety. However, there is debate on whether the risks of morphine outweigh the benefits.


• Afterload reducers. These drugs dilate the peripheral vessels and take a pressure load off the left ventricle. Some examples of afterload reducer medications include nitroprusside (Nitropress), enalapril (Vasotec) and captopril (Capoten).


• Blood pressure medications. If there is high blood pressure when developing pulmonary edema, these medications will help control it. On the other hand, if blood pressure is too low, drugs to raise it will be given.

Possible complications of pulmonary edema

• Abdominal swelling
• Buildup of fluid in the membranes that surround the lungs (pleural effusion)
• Congestion and swelling of the liver
• Leg swelling (edema)

Recovery and preventing recurrence

• Check Weight daily. Keeping a record of daily weight (in the morning before breakfast). Seek medical advice if there is a gain of 2 to 3 pounds (about 4 to 7 kilograms) in a single day.


• Controlling high blood pressure. Checking blood pressure with a home cuff at least once a day.


• Diet. Typically, people with pulmonary edema will need to follow a low-salt diet.


• Medical advice. Follow medical advice about controlling any underlying health problems, including guidance on diet, weight and exercise.


• Plenty of sleep. If feeling tired, napping during the day is recommended. Lung function may take as long as three to six months before returning to normal.

Prevention of pulmonary edema

• Control blood pressure. High blood pressure (hypertension) can lead to serious conditions such as stroke, cardiovascular disease and kidney failure. Most adults should take just a few minutes to have their blood pressure checked at least once every two years.
  
  A resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is considered normal. Blood pressure of consistently 140/90 mm Hg or higher, is an indication of high blood pressure. A reading in between these levels is in the prehypertensive category.
  
  In many cases, blood pressure can be lowered or maintained at a healthy level by getting regular exercise, eating a diet rich in fresh fruits, vegetables and low-fat dairy products, and limiting salt and alcohol.


• Blood cholesterol. Elevated cholesterol levels can cause fatty deposits to form in the arteries. This alters blood flow and increases the risk of vascular disease. But lifestyle changes can often keep cholesterol levels low. This includes limiting fats (especially saturated fats) eating more fiber, fish, and fresh fruits and vegetables, exercising regularly, stopping smoking, and drinking in moderation.


• Smoking. Smoking increases the risk of a second heart attack or heart-related death and also increases risk of lung cancer and other lung problems such as emphysema. In addition, exposure to secondhand smoke is a contributing factor to coronary artery disease.


• A heart-healthy diet. A diet rich in omega-3 fatty acids (found in fish) helps improve blood cholesterol levels and prevent blood clots. It is also important to eat plenty of fruits and vegetables, which contain antioxidants, vitamins and minerals. Reduce fat intake, especially animal (saturated) and trans fats (hydrogenated oils).


• Low-salt diet. Limit the use of salt (sodium). In some people with severely damaged left ventricular function, excess salt (even in a single meal or a bag of chips) may be enough to trigger congestive heart failure.


• Exercise regularly. Exercise is vital for a healthy heart. Regular aerobic exercise (about 30 minutes a day), helps control blood pressure and cholesterol levels, and maintain a healthy weight.


• Control weight. Being even slightly overweight increases the risk of cardiovascular disease. On the other hand, losing small amounts of weight can lower blood pressure, cholesterol and reduce the risk of diabetes.


• Taking baby aspirin. Seek medical advice about the pros and cons of taking one baby aspirin (81 milligrams) a day.


• Manage stress. To reduce the risk of heart problems, try to decrease stress levels.