pulmonary edema


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Related to pulmonary edema: congestive heart failure, pulmonary embolism

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

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.

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 ?
In our case, the patient presented to the emergency department with unexplained acute pulmonary edema. His B-type natriuretic peptide level, renal function test results, and echocardiography results were all within the normal range, thus excluding the possibilities of intravascular fluid overload, renal failure, and impairment of cardiac contractility.
B-lines are a sign of pulmonary edema but also a sign of interstitial pneumonia and severe pulmonary fibrosis, which may generate diffuse intensive B-lines [4, 15, 16].
Despite being standard of care in cardiogenic pulmonary edema, diuretics have a secondary role in the treatment of NPPE and should be given with discretion [6].
Chawla, "Neurogenic pulmonary edema," Critical Care, vol.
To the best of our knowledge, this study presents the first cases of pulmonary edema due to preeclampsia that were successfully managed with NPPV during pregnancy.
Mongovin et al., "Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic factor," JAMA, vol.
In this study, the MBT venom produced typical envenomation syndrome characterized by increased autonomic activity, alteration in cardiopulmonary parameters, and production of pulmonary edema. [4,9,10] Our data clearly demonstrate the instantaneous prolonged apnea followed by cardiac abnormalities after MBT venom.
If absent, we can rule out a hemodynamic pulmonary edema. Left cardiogenic shock is defined as low cardiac output associated with high LV filling pressure.
Keywords: Acute mountain illness, High altitude cerebral edema, High altitude pulmonary edema.
Reexpansion pulmonary edema is a life-threatening condition characterized by development of unilateral pulmonary edema in a lung that has been rapidly reinflated following a variable period of collapse secondary to a pleural effusion or pneumothorax.
AN Israeli man was rescued from a cruise ship headed to Larnaca early Friday while the vessel was off the coast of Paphos, after suffering pulmonary edema.
The most common neurologic diagnoses included encephalomyelitis (40% of patients), brainstem encephalitis (35%), encephalitis (11%), acute flaccid paralysis (7%), and neurogenic pulmonary edema (7%), a particularly severe form of EV71 disease.