Pulmonary edema is a dangerous medical condition that leads to excess amounts of fluid in the lungs, making an individual’s breathing difficult. It typically affects older individuals who have a heart condition, but it can affect younger patients who are involved in any kind of accident (most often vehicular accidents) that leads to a chest wall injury. Individuals who enter higher altitudes and struggle with altitude sickness are at risk of developing a particular type of pulmonary edema - (high-altitude pulmonary edema) - that requires specific treatment.
Definition & Facts
The lungs have numerous tiny air sacs called alveoli that can fill with fluid when someone has heart disease, pneumonia or a severe allergic reaction. Occasionally, too much exercise, living at a higher altitude, or a trauma to the rib cage can cause pulmonary edema, leading to impaired gas exchange that can cause respiratory failure.
This medical condition requires immediate medical attention in an emergency room to help an individual breathe normally. Anyone experiencing the symptoms of pulmonary edema must call paramedics for assistance right away. After ensuring that a patient is breathing normally, a physician also needs to begin the appropriate treatment for the underlying infection, disease, or injury.
Symptoms & Complaints
- Irregular rapid heartbeat
- Pain in the chest if the underlying cause is related to a heart condition
- Coughing that produces bloody sputum
- Mental anxiety
- An inability to rest
- Gasping for breath
- A suffocating sensation
- Difficulty breathing while asleep
- Shortness of breath when exercising
- Swelling in the legs and feet
- Rapidly gaining weight because of water retention
- Extreme fatigue
- Bluish skin caused by lack of oxygen (Cyanosis)
- Profuse perspiration
- Decrease in blood pressure (Hypotension)
- A crackling sound in the lungs
Fluid will also build up in the membranes around the lungs, making it more difficult to breathe. At the same time, fluid levels increase in the abdomen around the liver and in the legs, leading to additional discomfort for a patient.
While a healthy individual breathes, the air sacs in the lungs take in oxygen before releasing carbon dioxide with each breath. When an individual is suffering from pulmonary edema, the air sacs fill with fluid instead of air. Any oxygen that is still in the air sacs is unable to enter the body’s bloodstream. When the organs in the patient’s body do not get enough oxygen through the blood that passes through the veins, other problems begin to occur, including headaches, coughing, and fatigue.
Pulmonary edema is usually caused by a heart problem that involves the left ventricle, leading to congestive heart failure. If the left ventricle fails, it cannot push out the oxygen-rich blood it receives from the heart’s left atrium. Pressure then increases in the left atrium, and the fluid enters the capillaries in the lungs and eventually the lung’s air sacs. There are several reasons why the left ventricle of the heart can begin to fail including:
- Hypertension or high blood pressure
- Renal artery stenosis
- Kidney disease that leads to fluid retention
- Valvular heart disease involving the aortic valve or mitral valve
- Multiple blood transfusions after an accident or injury
- A reaction to venom from a snakebite or spider bite
- Coronary artery disease
Other problems with the body can also lead to pulmonary edema, including:
- Inhaling water or other liquids into the lungs
- Exposure to man-made or natural toxins
- Severe lung injury
- Viral infections
- Pulmonary embolism
- A reaction to prescription or illegal drugs
- Neurological disorders or diseases of the central nervous system
- Inhaling smoke during a fire
- High altitudes
- Acute respiratory distress syndrome
Diagnosis & Tests
When someone has pulmonary edema, the condition requires a trip to the emergency room rather than waiting for a routine doctor's visit, and paramedics will provide oxygen therapy immediately. After a patient is stabilized, more tests are required to determine the cause of the condition. Patients with pulmonary edema require examinations and tests from cardiologists and pulmonologists. The physicians will want to know more about a patient’s daily diet, lifestyle and medications. There is an assortment of medical tests available to help with the diagnosis of pulmonary edema, including:
- Cardiac catheterization
- Pulmonary artery catheterization
- Transesophageal echocardiography
- Blood tests
- Pulse oximetry
- X-rays of the chest
Treatment & Therapy
Patients who have pulmonary edema require medical intervention with medications or treatments to reduce the fluid in the lungs as quickly as possible. In addition, a physician will prescribe antibiotics to get rid of a lung infection or medications that are designed to treat a heart problem. If a patient has broken ribs or damage to the chest wall, then a surgical procedure may be required.
To help a patient feel more comfortable, a medical facility provides supplemental oxygen by giving a patient a breathing mask or inserting tubes into the lungs through the nose. Instead of reclining, most patients are placed in an upright position to make it easier to breathe. After a patient is stabilized, physicians begin to administer blood pressure and painkiller medications that help improve a patient’s breathing along with dilating the blood vessels.
Treatment will then focus on any underlying diseases, infections, or injuries. Depending on the cause of the pulmonary edema, lifestyle changes may be recommended. Patients are required to consume a healthier diet that does not include a lot of sodium. A physician will require a patient to stop smoking cigarettes and will suggest an exercise program.
Prevention & Prophylaxis
Anyone who travels to a high altitude should acclimate slowly, according to specific guidelines. There are also medications available to prevent high-altitude pulmonary edema, and mountain climbers should begin taking one of these medications before and after a high-altitude trip.