pulmonary edema

(redirected from Acute pulmonary edema)
Also found in: Acronyms, Encyclopedia, Wikipedia.

Pulmonary Edema

 

Definition

Pulmonary edema is a condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately.

Description

The build-up of fluid in the spaces outside the blood vessels of the lungs is called pulmonary edema. Pulmonary edema is a common complication of heart disorders, and most cases of the condition are associated with heart failure. Pulmonary edema can be a chronic condition, or it can develop suddenly and quickly become life threatening. The life-threatening type of pulmonary edema occurs when a large amount of fluid suddenly shifts from the pulmonary blood vessels into the lung, due to lung problems, heart attack, trauma, or toxic chemicals. It can also be the first sign of coronary heart disease.
In heart-related pulmonary edema, the heart's main chamber, the left ventricle, is weakened and does not function properly. The ventricle does not completely eject its contents, causing blood to back up and cardiac output to drop. The body responds by increasing blood pressure and fluid volume to compensate for the reduced cardiac output. This, in turn, increases the force against which the ventricle must expel blood. Blood backs up, forming a pool in the pulmonary blood vessels. Fluid leaks into the spaces between the tissues of the lungs and begins to accumulate. This process makes it more difficult for the lungs to expand. It also impedes the exchange of air and gases between the lungs and blood moving through lung blood vessels.

Causes and symptoms

Most cases of pulmonary edema are caused by failure of the heart's main chamber, the left ventricle. It can be brought on by an acute heart attack, severe ischemia, volume overload of the heart's left ventricle, and mitral stenosis. Non-heart-related pulmonary edema is caused by lung problems like pneumonia, an excess of intravenous fluids, some types of kidney disease, bad burns, liver disease, nutritional problems, and Hodgkin's disease. Non-heart-related pulmonary edema can also be caused by other conditions where the lungs do not drain properly, and conditions where the respiratory veins are blocked.
Early symptoms of pulmonary edema include:
  • shortness of breath upon exertion
  • sudden respiratory distress after sleep
  • difficulty breathing, except when sitting upright
  • coughing
In cases of severe pulmonary edema, these symptoms will worsen to:
  • labored and rapid breathing
  • frothy, bloody fluid containing pus coughed from the lungs (sputum)
  • a fast pulse and possibly serious disturbances in the heart's rhythm (atrial fibrillation, for example)
  • cold, clammy, sweaty, and bluish skin
  • a drop in blood pressure resulting in a thready pulse

Diagnosis

A doctor can usually diagnose pulmonary edema based on the patient's symptoms and a physical exam. Patients with pulmonary edema will have a rapid pulse, rapid breathing, abnormal breath and heart sounds, and enlarged neck veins. A chest x ray is often used to confirm the diagnosis. Arterial blood gas testing may be done. Sometimes pulmonary artery catheterization is performed to confirm that the patient has pulmonary edema and not a disease with similar symptoms (called adult respiratory distress syndrome or "noncardiogenic pulmonary edema").

Treatment

Pulmonary edema requires immediate emergency treatment. Treatment includes: placing the patient in a sitting position, oxygen, assisted or mechanical ventilation (in some cases), and drug therapy. The goal of treatment is to reduce the amount of fluid in the lungs, improve gas exchange and heart function, and, where possible, to correct the underlying disease.
To help the patient breathe better, he/she is placed in a sitting position. High concentrations of oxygen are administered. In cases where respiratory distress is severe, a mechanical ventilator and a tube down the throat (tracheal intubation) will be used to improve the delivery of oxygen. Non-invasive pressure support ventilation is a new treatment for pulmonary edema in which the patient breathes against a continuous flow of positive airway pressure, delivered through a face or nasal mask. Non-invasive pressure support ventilation decreases the effort required to breath, enhances oxygen and carbon dioxide exchange, and increases cardiac output.

Key terms

Edema — Swelling caused by accumulation of fluid in body tissues.
Ischemia — A condition in which the heart muscle receives an insufficient supply of blood and slowly starves.
Left ventricle — The large chamber on the lower left side of the heart. The left ventricle sends blood to the aorta and the rest of the body.
Mitral stenosis — Narrowing or constricting of the mitral valve, which separates the left atrium from the left ventricle.
Pulmonary — Referring to the lungs and respiratory system.
Drug therapy could include morphine, nitroglycerin, diuretics, angiotensin-converting enzyme (ACE) inhibitors, and vasodilators. Vasopressors are used for cardiogenic shock. Morphine is very effective in reducing the patient's anxiety, easing breathing, and improving blood flow. Nitroglycerin reduces pulmonary blood flow and decreases the volume of fluid entering the overloaded blood vessels. Diuretics, like furosemide (Lasix), promote the elimination of fluids through urination, helping to reduce pressure and fluids in the blood vessels. ACE inhibitors reduce the pressure against which the left ventricle must expel blood. In patients who have severe hypertension, a vasodilator such as nitroprusside sodium (Nipride) may be used. For cardiogenic shock, an adrenergic agent (like dopamine hydrochloride [Intropin], dobutamine hydrochloride [Dobutrex], or epinephrine) or a bipyridine (like amrinone lactate [Inocor] or milrinone lactate [Primacor]) are given.

Prognosis

Most patients with pulmonary edema who seek immediate treatment can be treated quickly and effectively.

Prevention

Cardiogenic pulmonary edema can sometimes be prevented by treating the underlying heart disease. These treatments, can including maintaining a healthy diet, taking appropriate medications correctly, and avoiding excess alcohol and salt.

Resources

Periodicals

Sacchetti, Alfred D., and Russel H. Harris. "Acute Cardiogenic Pulmonary Edema: What's the Latest in Emergency Treatment?" Postgraduate Medicine 103, no. 2 (February 1998): 145-166.

edema

 [ĕde´mah]
the accumulation of excess fluid in a fluid compartment. Formerly called dropsy and hydrops. adj., adj edem´atous. This accumulation can occur in the cells (cellular edema), in the intercellular spaces within tissues (interstitial edema), or in potential spaces within the body. Edema may also be classified by location, such as pulmonary edema or brain edema; types found in certain locations have specific names, such as ascites (peritoneal cavity), hydrothorax (pleural cavity), or hydropericardium (pericardial sac). Massive generalized edema is called anasarca. Classification by location does not indicate whether the edema is cellular or interstitial or occupies a potential space (for example, brain edema may be either cellular or interstitial). Edema can be caused by a variety of factors, including conditions that affect osmotic pressure, such as hypotonic fluid overload, which allows the movement of water into the intracellular space, or hypoproteinemia, which decreases the concentration of plasma proteins and permits the passage of fluid out of the blood vessels into the tissue spaces. Other factors include poor lymphatic drainage; conditions that cause increased capillary pressure, such as excessive retention of salt and water and heart failure; and conditions that increase capillary permeability, such as inflammation.
Edema formation. With trauma, increased capillary permeability and dilation cause leaking into tissue space. Initially clear, exudate in the tissue space becomes more viscous with an increase in plasma protein. From Copstead and Banasik, 2000.
alveolar edema pulmonary edema in the alveoli, usually with hypoxemia and dyspnea.
brain edema cerebral edema.
cardiac edema a manifestation of congestive heart failure, due to increased venous and capillary pressures and often associated with renal sodium retention.
cellular edema edema caused by the entry of water into the cells, causing them to swell. This may occur because of decreased osmolality of the fluid surrounding the cells, as in hypotonic fluid overload, or increased osmolality of the intracellular fluid, as in conditions that decrease the activity of the sodium pump of the cell membrane, allowing the concentration of sodium ions within the cell to increase.
cerebral edema swelling of the brain caused by the accumulation of fluid in the brain substance. It may result from head injury, stroke, infection, hypoxia, brain tumors, obstructive hydrocephalus, and lead encephalopathy; it may also be caused by disturbances in fluid and electrolyte balance that accompany hemodialysis and diabetic ketoacidosis. The most common type is vasogenic edema, which may result from increased capillary pressure or from increased capillary permeability caused by trauma to the capillary walls. Cellular edema may occur in ischemia or hypoxia of the brain. Because the brain is enclosed in the solid vault of the skull, edema compresses the blood vessels, decreasing the blood flow and causing ischemia and hypoxia, which in turn result in further edema. Unless measures are taken to reverse the edema, destruction of brain tissue and death will result.
dependent edema edema of the lowermost parts of the body relative to the heart; it is affected by gravity and position, so that the lower limbs are affected if the individual is standing, but the buttocks are affected if the individual is supine.
generalized edema edema that is caused by poor venous return; it is not localized by the effects of gravity, in contrast to dependent edema.
interstitial edema
1. edema caused by the accumulation of fluid in the extracellular spaces of a tissue.
2. pulmonary edema in the interstitial tissues; there is dyspnea but no hypoxemia.
edema neonato´rum sclerema neonatorum.
nonpitting edema edema in which pressure does not leave a depression in the tissues, such as in cellular edema. See also pitting edema.
pedal edema swelling of the feet and ankles.
peripheral edema edema affecting the extremities; seen in heart disease, Crohn's disease, and amyloidosis.
pitting edema edema in which external pressure leaves a persistent depression in the tissues (see pitting); it occurs because the pressure pushes the excess fluid out of the intercellular spaces in the tissue. See also nonpitting edema.
pulmonary edema diffuse extravascular accumulation of fluid in the tissues and air spaces of the lung due to changes in hydrostatic forces in the capillaries or to increased capillary permeability. It is most often symptomatic of left ventricular heart failure, but can also be a complication of mitral stenosis, aortic stenosis, altitude sickness, acute hypertension, volume overload during intravenous therapy, or reduced serum oncotic pressure, as in patients who have nephrosis, cirrhosis, or hypoalbuminemia.

During the initial stage of pulmonary edema, patients may complain of restlessness and anxiety and the feeling that they are getting a common cold. Other signs include a persistent cough, slight dyspnea, and intolerance to exercise. On auscultation, rales can be heard over the dependent portion of the lung. As fluid continues to fill the pulmonary interstitial spaces the dyspnea becomes more acute, respirations increase in rate, and there is audible wheezing. The cough becomes productive of frothy sputum tinged with blood, giving it a pinkish hue. Eventually, if the condition persists, the patient becomes less responsive to stimuli as levels of consciousness decrease. Ventricular arrhythmias develop and breath sounds diminish. In some patients these phases are telescoped as the pulmonary edema develops rapidly and the final stages of respiratory insufficiency are evident in a very short period of time.

Treatment is aimed at enhancing gas exchange, reducing fluid overload, and strengthening and slowing the heart beat. To accomplish these goals the patient is often given oxygen by mask or through mechanically assisted ventilation. Drug therapy includes diuretics to remove excess alveolar fluid and morphine to relieve anxiety and reduce the effort of breathing. Administration of other medications depends on the cause of the edema, as well as what other problems the patient may be having.
vasogenic edema that characterized by increased permeability of capillary endothelial cells; the most common form of cerebral edema.

pul·mo·nar·y e·de·ma

edema of lungs usually resulting from mitral stenosis or left ventricular failure.

pulmonary edema

the accumulation of extravascular fluid in lung tissues and alveoli, caused most commonly by congestive heart failure. Serous fluid is pushed through the pulmonary capillaries into alveoli and quickly enters bronchioles and bronchi. The condition also may occur in barbiturate and opiate poisoning, diffuse infections, hemorrhagic pancreatitis, and renal failure and after a stroke, skull fracture, near-drowning, inhalation of irritating gases, and rapid administration of whole blood, plasma, serum albumin, or IV fluids. See also pleural effusion.
observations Signs and symptoms of pulmonary edema include tachypnea; labored, shallow respirations; restlessness; apprehensiveness; air hunger; cyanosis; and blood-tinged or frothy pink sputum. The peripheral and neck veins are usually engorged, blood pressure and heart rate are increased, and the pulse may be full and pounding or weak and thready. There may be edema of the extremities, adventitious breath sounds in the lungs, respiratory acidosis, and profuse diaphoresis.
interventions Acute pulmonary edema is an emergency condition requiring prompt treatment. The patient is given oxygen and placed in bed in a high Fowler's position, and IV morphine sulfate is usually administered immediately to relieve pain, to quiet breathing, and to allay apprehension. Morphine also acts as a pulmonary vasodilator. A cardiotonic, such as digitalis or DOBUTamine, and a fast-acting diuretic, such as furosemide or bumetanide, may be given. Oxygen may be ordered. While the patient is acutely ill, the blood pressure, respiration, apical pulse, and breath sounds are checked frequently or continually monitored. Parenteral fluids, if indicated, are infused slowly in limited quantities; a low-sodium diet is served; and the patient's intake and output of fluids are measured. The patient is weighed daily, and any sudden weight gain is noted and reported.
nursing considerations The nurse provides continued care and emotional support and directs the patient to exercise to tolerance with frequent rest periods, to report any symptoms, to avoid smoking, and to follow the regimen ordered for medication, diet, and return checkups.

pulmonary edema

Lung water, water in the lung Internal medicine The exudation of protein-rich fluid due to heart failure–eg, left ventricular failure, aortic or mitral valve stenosis, post-MI, or high altitude Management Furosemide. See Congestive hear failure.

pul·mo·nar·y e·de·ma

(pul'mŏ-nar-ē ĕ-dē'mă)
Accumulation of extravascular fluid in lung tissues and alveoli usually resulting from mitral stenosis or left ventricular failure.

pul·mo·nar·y e·de·ma

(pul'mŏ-nar-ē ĕ-dē'mă)
Accumulation of extravascular fluid in lung tissues and alveoli usually resulting from mitral stenosis or left ventricular failure.

pulmonary edema (pŏŏl´məner´ē edē´mə),

n the accumulation of extravascular fluid in lung tissues and alveoli, caused most commonly by congestive heart failure.

pulmonary

pertaining to the lungs, or to the pulmonary artery. See also lung.

pulmonary abscess
causes a syndrome of chronic toxemia, cough, loss of body weight. Careful auscultation may elicit squeaky rales around the lesions. See also caudal vena caval thrombosis, aspiration pneumonia.
pulmonary acinus
basic structural unit of the lung parenchyma; the gas exchange unit, supplied by a single terminal bronchiole and includes branches of the terminal bronchiole, alveolar ducts, alveolar sacs, alveoli and associated blood vessels. A pulmonary lobule consists of many acini.
pulmonary agenesis
incompatible with life; found only in fetal or neonatal necropsy specimens.
pulmonary alveolar microlithiasis
see microlithiasis alveolaris pulmonum.
pulmonary alveolar parenchyma
include epithelial cells (pneumonocytes or pneumocytes), alveolar capillary endothelial cells, and interstitial cells (fibroblasts) and alveolar macrophages.
pulmonary alveolar proteinosis
a disease of unknown etiology marked by chronic filling of the alveoli with a proteinaceous, lipid-rich, granular material consisting of surfactant and the debris of necrotic cells.
pulmonary arteriopathy
pulmonary artery wedge pressure
see wedge pressure.
pulmonary atelectasis
pulmonary bed
the network of capillaries in lung tissue.
pulmonary calcinosis
see microlithiasis alveolaris pulmonum.
pulmonary calculus
see bronchial calculus.
pulmonary carcinomatosis
see ovine pulmonary adenomatosis (below).
pulmonary circulation
the circulation of blood to and from the lungs. Deoxygenated blood from the right ventricle flows through the right and left pulmonary arteries to the right and left lung. After entering the lungs, the branches subdivide, finally emerging as capillaries which surround the alveoli and release the carbon dioxide in exchange for oxygen. The capillaries unite gradually and assume the characteristics of veins. These veins join to form the pulmonary veins, which return the oxygenated blood to the left atrium. See also circulatory system.
pulmonary compliance
a measure of the ability of the lung to distend in response to pressure without disruption. Expressed as the unit volume of change in the lung per unit of pressure. Compliance or distensibility of the lung is increased in conditions such as emphysema in which the lung distends more readily, and is decreased in fibrotic conditions in which the lung distends with difficulty. See also compliance.
pulmonary congestion
caused by engorgement of the pulmonary vascular bed and it may precede pulmonary edema when the intravascular fluid escapes into the parenchyma and the alveoli. There is a loss of air space and the development of respiratory embarrassment.
pulmonary cysts
may be congenital or acquired, caused by trauma, parasites (Paragonimus spp.), or associated with bronchiectasis. Rarely, metastatic tumors cavitate forming cysts.
pulmonary defense mechanisms
include aerodynamic filtration in nasal cavities, sneezing, local nasal antibody, laryngeal and cough reflexes, mucociliary transport mechanisms, alveolar macrophages, systemic and local antibody systems.
pulmonary edema
an effusion of serous fluid into the pulmonary interstitial tissues and alveoli. Preceded by pulmonary congestion (see above). If the extravascular exudation is sufficiently severe a critical level of hypoxia may be reached. The breathing will then be labored, the normal breath sounds on auscultation may be absent, and a frothy nasal discharge, often blood-tinged, may appear. At this stage the animal's life is about to terminate.
pulmonary embolus
obstruction of the pulmonary artery or one of its branches by an embolus. The embolus usually is a blood clot swept into circulation from a large peripheral vein.
Signs vary greatly, depending on the extent to which the lung is involved. Simple, uncomplicated embolism produces such cardiopulmonary signs as dyspnea, tachypnea, persistent cough, pleuritic pain and hemoptysis. On rare occasions the cardiopulmonary signs may be acute, occurring suddenly and quickly producing cyanosis and shock. A septic embolus can lead to local pulmonary abscess or an extension to pneumonia as in caudal vena caval syndrome. See also caudal vena caval thrombosis, pulmonary abscess (above).
pulmonary eosinophilic granulomatosis
a lesion common in heartworm disease; eosinophiles and neutrophils surround trapped microfilariae causing nodules as large as 3 inches diameter. May be preceded by lesions of allergic pneumonitis.
exercise-induced pulmonary hemorrhage
traces of blood can be found in about 60% of horses after racing. Less than 1% of these bleed from the nostrils. See also epistaxis.
pulmonary function tests
tests used to evaluate lung mechanics, gas exchange, pulmonary blood flow and blood acid-base balance. Pulmonary function testing is used to detect emphysema and chronic obstructive bronchitis at an early stage.
pulmonary hemorrhage
as distinct from hemothorax, is recognized because of a syndrome of dyspnea, increased lung density radiographically, and hemorrhagic anemia. If a large vessel ruptures into an abscess cavity there is usually a massive hemoptysis and instant death. Frothy blood-stained nasal discharge is an indication of pulmonary edema rather than of pulmonary hemorrhage. See also exercise-induced pulmonary hemorrhage (above).
pulmonary horse sickness
the predominantly pulmonary form of african horse sickness.
pulmonary hypertrophic osteoarthropathy
see hypertrophic osteopathy.
pulmonary hypoplasia
a congenital defect resulting in decreased lung development.
pulmonary infarction
see pulmonary infarction, pulmonary embolus (above).
pulmonary infiltration with eosinophilia (PIE)
pulmonary malformation
includes accessory lungs, pulmonary hypoplasia, pulmonary agenesis, congenital pulmonary cysts, endodermal heteroplasia, respiratory distress syndrome, neonatal maladjustment syndrome, immotile cilia syndrome.
pulmonary mycoses
includes aspergillosis, mortierellosis, blastomycosis, cryptococcosis, coccidioidomycosis.
pulmonary neoplasm
many types are recorded in all species but the prevalence is very low in food animals. A common site for metastases in companion animals. Characterized clinically by decreased exercise tolerance, progressive dyspnea, chronic cough and emaciation. Most diagnoses result from radiographic examination of the thorax for secondary growths.
neurogenic pulmonary edema
results from head trauma, central nervous system lesions and toxins, which may cause increased pulmonary blood pressure and alteration to sympathetic innervation leading to fluid leakage from vessels.
overriding pulmonary artery
see overriding pulmonary artery.
ovine pulmonary adenomatosis
a very chronic progressive pneumonia of sheep and goats caused by a retrovirus. Dyspnea, emaciation and a profuse nasal discharge are the cardinal signs, but coughing is not evident. The disease is always fatal. It is of great importance if it occurs in flocks that are housed for long periods. Characteristically the extensive lung involvement includes large areas of neoplastic tissue. Called also jaagsiekte, pulmonary carcinomatosis.
pulmonary patterns
see alveologram pattern, bronchial pattern.
re-expansion pulmonary edema
edema, emphysematous bullae and serosanguinous fluid in the airways with generalized pulmonary capillary endothelial damage; associated with chronic pulmonary collapse and removal of pleural effusions or pneumothorax with rapid re-expansion.
pulmonary rupture
traumatic, especially when there is rib fracture, or spontaneous due to coughing and a weak parenchyma. The most common cause of pneumothorax.
pulmonary thromboembolic disease
thromboembolism causing blockage of large sections of the pulmonary vascular bed will result in at least temporary severe dyspnea. It may also lead to right heart congestive failure, i.e. cor pulmonale.
pulmonary thrombosis
pulmonary valve
the pocket-like structure that guards the orifice between the right ventricle and the pulmonary artery.
pulmonary valve stenosis
causes right ventricular hypertrophy and a poststenotic dilatation of the pulmonary artery. There is a systolic murmur and thrill on the left side of the chest. A common congenital defect in dogs.
pulmonary vein
the large vein (right and left branches) that carries oxygenated blood from the lungs to the left atrium of the heart.
pulmonary wedge pressure
see wedge pressure.

Patient discussion about pulmonary edema

Q. what is "pulmonary edema" and what are the risks? my Dr. told me I'm in a risk group for pulmonary edema, he tried to explain what it is but i didn't understand fully...if someone may give me a brief explanation- I'll appreciate it!

A. pulmonary edema occurs when, lets say, your heart left ventricle stops working properly and your right ventricle works fine. that means your lungs getting lets presume- 1 liter of blood -but your left ventricle can pump out of it only 990 ml. that means you have high blood pressure in your lungs and fluid comes out of blood vessels and fills your lungs, making it harder and harder breathing.

More discussions about pulmonary edema
References in periodicals archive ?
They included one patient suffering from acute pulmonary edema and two patients suffering from endstage renal failure.
BOXING: Edwin Rosario, a former lightweight champion whose career was marred by cocaine, died of acute pulmonary edema that could have been caused by drug or alcohol abuse, a pathologist said.
If patients develop acute pulmonary edema during initiation of therapy with vasodilating agents such as Letairis, the possibility of pulmonary veno-occlusive disease should be considered, and if confirmed, Letairis should be discontinued.

Full browser ?