Pulmonary Edema

1 What is Pulmonary Edema?

Pulmonary edema is a serious condition where the lungs are filled with fluid, preventing respiration and causing difficulties in breathing. It is often a feature in people with heart problems like congestive heart failure. If not addressed immediately, pulmonary edema can cause death.

You can also have pulmonary edema due to pneumonia, injuries to the chest, effects of poisons and overdose of medications, travelling and living in very high-altitude regions (termed high-altitude pulmonary edema or HAPE).

Some cases of pulmonary edema develop rapidly, termed as acute pulmonary edema, which requires immediate emergency care. Pulmonary edema is treated with supplemental oxygen and medications, as well as treating the underlying cause.

2 Symptoms

Symptoms of pulmonary edema can develop over time or appear suddenly.

Here are the symptoms of acute pulmonary edema:

If you have one or more of these symptoms, and also have a history of heart problems, call the local emergency hotlines for medical assistance and go to the hospital as soon as possible.

Pulmonary edema that is chronic or gradually developing may cause the following symptoms:

  • Shortness of breath or difficulty breathing during exertion.
  • Breathing difficulties worsened by lying flat.
  • Wheezing sounds.
  • Waking up at night due to shortness of breath often relieved while standing up.
  • Rapid weight gain due to fluid buildup. 
  • Noticeable fluid swelling in the arms or legs.
  • Unexplainable fatigue.

Here are the symptoms of high-altitude pulmonary edema (HAPE):

  • Headaches
  • Fever
  • Palpitations
  • Discomfort in the chest
  • Shortness of breath after exertion that persists at rest.
  • Difficulties walking uphill, that then proceed to difficulties walking on flat terrain.
  • Coughing frothy sputum that may be tinged with blood.

See a doctor immediately or call emergency hotlines if you have the following symptoms, especially if you have history of pulmonary edema or heart disease:

  • Sudden shortness of breath
  • Feeling of getting suffocated or trouble in breathing with profuse sweating
  • Presence of wheezing, bubbly or gasping sounds while breathing
  • Expectoration of frothy, pink or blood-tinged sputum
  • Bluish or grayish tone of the skin
  • Lightheadedness, dizziness, weakness and sweating, due to drop in blood pressure
  • Sudden worsening of symptoms

Call someone to help you in calling emergency hotlines and driving you to the hospital.

3 Causes

Pulmonary edema causes your lungs to ‘drown’ from fluid buildup. The lungs are packed with numerous tiny air-filled sacs called alveoli. The alveoli contain tiny blood vessels that absorb oxygen and releases carbon dioxide in each breath.

Fluid in the alveoli prevents the exchange of oxygen and carbon dioxide, causing shortness of breath and reduced oxygen levels in the body. Several health conditions cause fluid buildup in the lungs, but most are caused by problems in the heart. 

The heart has left and right side. The right side receives deoxygenated blood from the body and pumps it to the lungs so it will be enriched in oxygen and removed of carbon dioxide. The left side of the heart receives oxygenated blood from the lungs and pumps it throughout the whole body. 

Pulmonary edema occurs if the heart cannot pump enough blood due to high blood pressures, problems in the heart valves, or to coronary artery disease. Since the heart cannot pump enough blood to the body, it to backs up in the lungs causing fluid to seep out of blood vessels in the alveoli, resulting in fluid buildup in the lungs. 

Here are the heart problems that may cause pulmonary edema:

  • Coronary artery disease – coronary arteries supply the heart with oxygen and nutrients. Fatty deposits called plaques can narrow the coronary arteries, and if a clot completely blocks the opening, results to a heart attack. If the patient survives, the heart cannot work as efficiently, causing blood to slowly back up the lungs. Coronary artery disease tends to cause chronic pulmonary edema.
  • Cardiomyopathy – this is the disease of the heart muscles itself. The heart muscles make the heart contract and pump blood. Cardiomyopathy can cause problems to the functioning of the heart and makes it unable to pump more blood during increased demands. If demand for blood is high and the heart cannot pump enough, blood gradually backs up into the lungs and cause pulmonary edema.
  • Heart valve problems – the heart has valves so the blood will not back out during each contraction. Problems like mitral valve disease and aortic valve disease are problems in the heart valves. These can cause blood to leak and back up the lungs, causing pulmonary edema.
  • Untreated hypertension – blood pressure can become so high that it causes fluid formation in the lungs, causing pulmonary edema.

You can also get pulmonary edema without any heart problems. Here are some conditions that cause fluid buildup in the lungs:

  • Acute respiratory distress syndrome (ARDS) – this condition causes the lungs to suddenly fill up with fluid. Trauma, systemic infection, pneumonia and severe bleeding are some of the causes of ARDS.
  • Travelling in high-altitude regions – this causes high-altitude pulmonary edema (HAPE). It is a risk to individuals travelling or exploring high-altitude places without getting acclimatized. The exact reasons for this are not well known, but it often affects mountaineers, hikers, and skiers. 
  • Injuries to the head – pulmonary edema can happen to people who sustained head injuries, seizures or bleeding inside the head. It can also affect patients who underwent brain surgery. 
  • Pulmonary embolism – is caused by blockage of an artery in the lungs by a blood clot that usually comes from the legs. It can also cause pulmonary edema.
  • Near drowning – the experience of near drowning can put water into the lungs causing pulmonary edema. 
  • Viral infections in the lungs – diseases like hantavirus and dengue virus is associated with pulmonary edema. 
  • Injuries to the lungs – like gunshots, blunt trauma or lung surgery can cause blood or fluid to seep inside the alveoli and cause pulmonary edema. 
  • Certain toxins – like ammonia, chlorine, and volatile chemicals can cause irritation in the lungs, causing fluid formation that can lead to pulmonary edema.

4 Making a Diagnosis

Because pulmonary edema needs immediate medical car, you'll initially be diagnosed on the basis of your symptoms and a physical exam, electrocardiogram and chest X-ray.

You need to stay in the hospital for several days. Depending on your health problems, you might be referred to a cardiologist (a doctor specializing in heart disease) or pulmonologist (treats lung conditions).

You can receive outpatient care once your condition has stabilized.

You can do these tips to help improve your care

  • Write down important things like felt symptoms and the times they appeared, medications taken and body weight readings. Also, write down symptoms you had experienced in the past that you are recently experiencing.
  • Your doctor might need your medical records, especially if you are changing doctor. Make sure to always bring copies with you.
  • List down salty foods you eat regularly and indicate if you ate more. 

It can be helpful to bring a family member or spouse along during appointments to help you get all information you need.

You can also ask your doctor questions

Here are some good questions to ask:

  • What are the likely causes of my symptoms?
  • What are the tests I need? Do I have to do some preparations or restrictions?
  • Can you tell me the results of my X-rays and electrocardiograms?
  • What could be the best treatment for my case?
  • What are the side effects of the treatment?
  • What is the prognosis of my case?
  • Do I have to stick to diet restrictions?
  • Can you share to me websites or printed material to help me understand my condition?

During appointments, your doctor may ask you to share information about the following:

  • Description of your symptoms.
  • Your salt intake.
  • The severity of your symptoms. Do they affect your daily activities or performance at work?
  • Do you snore excessively?
  • Things that seem to worsen or improve your symptoms
  • Do you smoke or have you smoked in the past? 
  • Family history of conditions like heart and lung disease, chronic obstructive pulmonary disease (COPD) and asthma.
  • Exercise levels every day.
  • Recent trips to high-altitude places.

5 Treatment

Pulmonary edema causes oxygen deprivation, so the first step in pulmonary edema treatment is oxygen therapy.

Emergency services may give you oxygen through a face mask to ease your symptoms. Sometimes, you will be hooked to a mechanical ventilator in case you have difficulty breathing. Health providers will constantly monitor oxygen levels in your body.

Medications can help relieve factors that cause pulmonary edema:

  • Drugs like water pills (diuretics) helps reduce blood pressure. Diuretics reduce fluids in the bloodstream by promoting urination to relieve pulmonary edema.
  • Narcotics like morphine may be given to help relieve anxiety and shortness of breath. Anxiety may increase your demand for oxygen and worsen pulmonary edema.
  • In some cases, the doctor may give nifedipine (Procardia) or nitroprusside (Nitropress). These drugs lower blood pressure and open up coronary arteries to improve oxygen delivery to the heart. Antihypertensives are also indicated as maintenance drugs for pulmonary edema patients with hypertension.

Treating high-altitude pulmonary hypertension (HAPE)

If you are in high-altitude regions and you have HAPE, you need to get down to 600 to 900 meters (2,000 to 3000 feet) above sea level as quickly as possible. Try to reduce physical activity and reduce colds. These can resolve the symptoms of pulmonary edema.

Hyperbaric chambers imitate the air pressures in high altitudes and can be used for treatment of HAPE. It can be used to subject the patient to pressures imitating descent.

Nifedipine may help reduce pressure in the pulmonary arteries and is also taken. These measures usually improve symptoms. If the patient’s condition continues to become worse, he or she needs to be rescued by a helicopter since HAPE can cause death.

Proper acclimatization and taking medications such as acetazolamide (Diamox) and nifedipine reduces the risk of HAPE. Medicines must be taken at least a day or two before the ascent.

6 Prevention

If you have heart conditions, there are things you can do to prevent pulmonary edema:

  • Treat hypertension – very high blood pressure can worsen heart disease. Hypertension itself is a risk factor for pulmonary edema because of its tendency to cause blood to back up the lungs. You can get your blood pressure to normal levels by having regular exercise, eating more fresh fruits and vegetables and trying to lose weight. Limiting salt and alcohol is also helpful.
  • Monitor your cholesterol – high cholesterol levels is not good for your arteries. It promotes the buildup of plaques that narrows arteries, which is not good if you have coronary artery disease or have suffered a heart attack. Keep your cholesterol at healthy levels by reducing intake of saturated fat while increasing consumption of fresh fruits, vegetables, and oily fish.
  • Stop using tobacco and excessive alcohol – tobacco and excess alcohol contributes to heart disease and worsens the health of patients with heart problems. Tobacco also irritates the lungs and is associated with lung problems. If you have drinking problems or unable to quit smoking, ask your doctor for help.
  • Reduce salt intake and eat a healthy diet – limiting salt in your food and eating more fresh fruits and vegetables is good for the heart. To cut back on salt, avoid processed foods, cheese, and cured meats, and you use herbs instead to add flavor to food.
  • Exercise on a regular basis – it is important that you have decent physical activity levels every day. Make it a point to spend at least 30 minutes per day doing exerting or strenuous activities like brisk walking, bicycling, lifting weights or jogging. 
  • Lose weight – most people with heart disease are overweight or obese, and the risk of having heart complications is drastically reduced by losing even small amounts of weight. 
  • Learn to handle stress – stress affects the mind and the body, especially the heart. Stress makes the heart work harder. Learn to give yourself some form of relief from stress. Take up a sport or interesting hobby, socialize with friends or family. 

How to prevent high-altitude pulmonary edema?

High-altitude pulmonary edema (HAPE) is often a problem to hikers or mountaineers that did not spend enough time acclimatizing.

Acclimatization helps your body and lungs adjust to thinner air and lower air pressure in high-altitudes.
Going to places at altitudes of 2,500 meters (8,200 feet) and above requires proper acclimatization. Climbers should ascent no more than 305 to 366 meters (1,000 to 1,200 feet) a day. Rest for around a day every time you ascent to around 183 to 366 meters.

Aside from acclimatization, you can also take prescription medicines acetazolamide (Diamox Sequels) or nifedipine (Procardia). To prevent HAPE, take medication one or two days before the ascent and continue taking them for about five days after ascending.

7 Lifestyle and Coping

Lifestyle changes are helpful if you are at risk or experienced previous episodes of pulmonary edema. Your doctor may recommend you the following:

  • Monitor blood pressure and take your medications for hypertension regularly, even if your blood pressure seems normal.
  • If you have diabetes, do monitor glucose levels on a regular basis to prevent complications.
  • Try to quit, even if you have several unsuccessful attempts before. Tobacco harms your heart and lungs. 
  • Stick to a healthy diet to reduce the risk of heart problems. Fill your plate with fresh fruits and veggies and oily fish while reducing consumption of salt, processed meat and red meats. 
  • Lose weight and exercise regularly.
  • Avoid things that worsen your condition.

8 Risks and Complications

There are several complications associated with pulmonary edema.

Pulmonary edema makes it hard for the lungs to get oxygen from the air and remove carbon dioxide from the blood.

This causes low oxygen levels in vital organs like the brain and the heart.

Aside from causing low oxygen levels, pulmonary edema can raise blood pressure in the pulmonary artery, which carries blood from the right side of the heart to the lungs. Unlike the heart’s left side, the right side is thinner and less capable in handling elevated blood pressures. The right side of the heart is connected to the central vein that receives blood from the whole body.

Therefore, blood backs up to these veins and causes the following complications:

  • Liver congestion and swelling. The liver is connected to the major veins that go to the heart, so it is often affected by pulmonary hypertension and right-sided heart problems.
  • Pleural effusion, or buildup of fluid around the lungs. This reduces the ability of the lungs to expand, making it difficult to breath.
  • Swelling in the abdomen and legs

Take note that untreated pulmonary edema can cause death.

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