pulmonary edema (redirected from Cardiogenic pulmonary edema)

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.

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edema /ede·ma/ (ĕ-de´mah) an abnormal accumulation of fluid in intercellular spaces of the body.edem´atous

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angioneurotic edema  angioedema.

cardiac edema  a manifestation of congestive heart failure, due to increased venous and capillary pressures and often associated with renal sodium retention.

cytotoxic edema  cerebral edema caused by hypoxic injury to brain tissue and decreased functioning of the cellular sodium pump so that the cellular elements accumulate fluid.

dependent edema  edema in lower or dependent parts of the body.

edema neonato´rum  a disease of premature and feeble infants resembling sclerema, marked by spreading edema with cold, livid skin.

pitting edema  that in which pressure leaves a persistent depression in the tissues.

pulmonary edema  diffuse edema in pulmonary tissues and air spaces due to changes in hydrostatic forces in capillaries or to increased capillary permeability, with intense dyspnea.

vasogenic edema  cerebral edema in the area around tumors, often due to increased permeability of capillary endothelial cells.

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pulmonary edema

n.

Edema of the lungs usually due to mitral stenosis or left ventricular failure.

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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.

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pulmonary edema (pl´mner´ē edē´m),

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

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pulmonary

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

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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

see aelurostrongylus.

pulmonary artery wedge pressure

see wedge pressure.

pulmonary atelectasis

see 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)

see pie syndrome.

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

see thromboembolism.

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.

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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. Cf Congestive hear failure.

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Patient discussion about Cardiogenic 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.