What Is Pulmonary Edema?

Introduction

Pulmonary is defined as Lungs and Edema is defined as swelling.

Alveoli are tiny air-sacs that are situated in the lungs. The blood which passes by takes up the oxygen from the air whereas carbon-dioxide which is present in the blood is transferred to the alveoli to be removed out of the body. This exchange of air is possible only because, alveoli has a thin wall to permit/allow this. Fluids are kept away from the alveoli unless the thin walls of the alveoli lose their “integrity”, resulting in excess accumulation of the fluid.

Pulmonary Edema is defined as an excess build-up of fluids in the lungs. This causes difficulty in breathing because excess fluid gets accumulated in various air-sacs called alveoli. The excess fluid in the lungs makes the exchange of oxygen and carbon dioxide between cells and blood-stream hard and strenuous resulting in the lungs not able to perform its functions. In layman’s language, this condition can be explained as “water in the lungs” for them to understand properly.

The major cause of Pulmonary Edema is heart illnesses/heart diseases. There could be other various reasons due to which the fluid build-up occurs such as pneumonia, individuals being vulnerable to certain medicines and toxins, Chest wall has been traumatized or doing exercises at higher altitudes.

Pulmonary Edema could also happen instantly, which is called Acute Pulmonary Edema. This should be treated as a medical emergency.

Causes of Pulmonary Embolism

When there is an excess build-up of fluid in the body, it could lead to two things i.e.

• The body is not able to expel out carbon-dioxide.
• Bloodstream is not able to get a sufficient amount of oxygen.

Cardiogenic Factors Include

• Congestive Heart Failure (CHF): When the heart is not able to pump the blood properly throughout the body, this results in CHF. This causes a back-log of pressure created in the lungs among the small blood vessels, resulting in the leakage of fluids via the blood vessels. This will prevent the proper flow of oxygen in the body.

• Coronary Artery Disease: Due to accumulation of the plaque or fatty deposits in the coronary artery resulting it to get narrowed and decreasing the supply of blood to the heart. Heart Attack or other heart conditions come up when the blood clot is situated in one of the narrowed arteries, clogs the flow of blood and affects a part of the heart muscle. This results in the heart muscle which is damage to not work properly in terms of its functions to be performed. In this condition, the heart and its functions become weak, which causes the backlog of the blood in the lungs, which results in the blood to move from the capillary walls to tiny air sacs named alveoli. This is called a chronic congestive failure.

• Cardiomyopathy: This is when the muscle of the heart is affected. This affects the ventricles of the heart, which is considered to be the main pump for the heart. The outcome is that the heart has to work hard, resulting in infections of retaining the fluids. If the left ventricle is not able to perform its functions well, it results in fluid accumulation in the lungs causing pulmonary edema.
• Heart Valves getting narrowed or damaged: In valve diseases such as a mitral valve or aortic valve disease results in the blood not getting regulated properly, the valves may not wide open or may not shut-down properly causing the blood to move backward i.e. regurgitation. The load on the left ventricle increases. This increase in the pressure goes up-to-the left atrium and to the pulmonary veins, resulting in fluid build-up in the lungs.
• Hypertension: If not treated or uncontrolled results in enlargement of the heart.

External (Non-Cardiogenic) Factors causing Pulmonary Edema

• Exposed to high altitude pressure: There are chances of developing HAPE (High Altitudes Pulmonary Edema) for those individuals who move around to high-altitudes like mountain climbers. This majorly occurs at altitudes above 8,000 feet i.e. 2,400 meters, even to those individuals like hikers or skiers as before getting adapted they started exercising at high altitudes. This condition of HAPE occurs majorly due to the narrowing of the pulmonary capillaries.
• Overdose or extra usage of drugs: Some of the illegal drugs like:
• Toxin inhalation results in damage to the lungs: Some toxins which are inhaled from outside (i.e. environmental toxins) or something which moves within the body. Like for example: While vomiting, aspiration of some of the stomach contents. Or if inhalation of toxins it results in the airways and air sacs getting irritated causes the build-up of the fluids.
• Extreme Traumatization
• Severe and many injuries
• Drowning: When water goes inside the body, it results in “non-cardiogenic pulmonary edema”, which if attended immediately can be altered.
• Smoking: If the inhalation of smoke is through the fire, it results in inhalation of dangerous and harmful chemicals that affects the alveoli (tiny air sacs) and the capillaries, causing entry of fluids in your lungs.
• Viral Infections: Pulmonary Edema conditions can result from viruses such as dengue virus and Hantavirus.
• Pulmonary Embolism: This problem occurs while the blood clot moves to the lungs via the blood vessels of the legs, resulting in pulmonary edema.
• Conditions of the Nervous System: If there have been some conditions related to Nervous system or any treatments related to it like a head injury or seizures after undergoing surgery for the head, it results in a type of pulmonary edema named neurogenic pulmonary edema.
• Acute Respiratory Distress Syndrome (ARDS): This condition occurs when the lungs are accumulated with white blood cells and fluid. ARDS is a result of several conditions like injuries or trauma, sepsis (infection), pneumonia and excess bleeding.
• Pneumonia
• Failure of the kidney
• The infection causes damage to the lungs
• Sepsis of the blood or infection causes the blood to be poisoned

Signs and Symptoms are seen in Acute Pulmonary Edema

• Breathlessness or Dyspnea that increases with any activity or when a person lies down.
• Sort of suffocation or drowning feeling especially when in a sleeping position.
• Panting for breath.
• Cold and moist skin.
• Eager or restless.
• Cough which contains sputum that is frothy (foaming) with slight blood in it.
• Lips become slight blue.
• Heart-beat becomes fast and not regular

Signs and Symptoms of Chronic Pulmonary Edema

• Excess Breathlessness.
• When exerting, breathing problems increases.
• When in the lying position, breathing difficulty increases.
• Breathing sounds become audible and noisy.
• Getting up from sleep with a feeling of breathless and a slight cough, which is proper once in an upright position.
• Very fast weight gain.
• Tiredness.

Signs and Symptoms for Pulmonary Edema at higher altitudes

• Breathless when exerting and even when at rest.
• Cough
• Problems in walking upwards on hills, which gradually increases to the problem when walking on flat surfaces.
• Fever
• Tiredness
• Cough which contains sputum that is frothy (foaming) with slight blood in it.
• Not regular and fast heartbeats
• Discomfort in the chest
• An ache in the head (Headache)

Complications

Once the Pulmonary edema increases, it causes the pressure to increase in the pulmonary artery, resulting in the right ventricle becoming weak and starting to fail. This increase in the pressure, causes the back up in the right atrium and the different areas of the body, resulting in:

• Swelling in the abdomen and extremity.
• Fluid build-up in the membranes that are around the lungs (pleural effusion).
• The liver gets congested and swelling occurs.

If this is untreated, it can result in danger.

Diagnosis for Pulmonary Edema

Tests to be done to diagnose for Pulmonary Edema:

Chest X-Ray: This is the initial test to be done to get a confirmation for the detection of pulmonary edema and helps to identify the cause for breathlessness.

Pulse Oximetry: This helps to identify how much oxygen is present in the blood via a sensor (which uses light) that is attached to the finger or ear.

Blood Tests: Blood is removed from the artery in your wrist, to check the quantity of gas i.e. oxygen and carbon dioxide is present).

Also, a particular substance will be checked for in the blood called B-type natriuretic peptide (BPN). High levels of BPN determines that pulmonary edema is a result of heart disease. Blood Tests also include tests for kidney, thyroid and blood count.

Electrocardiogram (ECG): This is not invasive. This depicts a lot about the information of the heart. In this process of ECG, there are patches connected to your skin that gets electrical impulses/signals from your heart.

These are depicted in the form of waves on the graph paper or the monitor screen. Wave depicts two things i.e. heart rate and rhythm and which parts of the heart depict a decrease in the blood flow.

Echocardiogram: This is also not an invasive test that makes use of a device that is of a wand-shaped called a transducer to produce sound waves of a high rate that are reflected from the heart tissues. These sound waves are then transferred to a machine that forms the pictures of your heart on the screen or monitor. This helps detect various heart issues like valve disease, pleural effusion (fluid around the heart), congenital heart defects. It also identifies the flow of blood in your heart and how efficiently is the heart pumping blood.

Cardiac Catheterization: If ECG or EEG, do not show effective results or identify the cause for Pulmonary Edema, the doctor further suggests cardiac catheterization and angiogram.

Using an X-Ray imaging the doctor passes a long-narrow catheter in the vein or artery of the neck, arm or groin (the area between upper thigh and abdomen) and passes it from the blood vessels to your heart. Then dye is inserted in the blood vessels of your heart to be made to see. During this, the doctors can also perform certain activities that open up the blocked arteries, which increases the function of the left ventricle. This method of cardiac catheterization also helps check the pressure in the chambers of the heart and analyzes the valves of the heart to find out for the reason behind pulmonary edema.

Treatments to be done

To give oxygen through a face mask or nasal cannula. This helps relieve some of the symptoms. This will be very attentively taken care of by the doctors.

Sometimes even Mechanical Ventilator might be needed that gives a positive air-way pressure.

Depending on your medical condition, you might be getting some medicines such as:

Diuretics: This includes Lasix (Furosemide), this helps remove excess fluid from the body i.e. heart and lungs.

Morphine (MS Contin): This helps get relief from breathlessness and eagerness. But sometimes according to the Doctors, the risks for this medicine is much more than the benefits and it is useful to use other medicines than this one.

Hypertensive Medications: According to the blood pressure being high or low, medications will be prescribed. There are medications given to either pre-load or afterload reducers i.e. going into or out of accordingly. Nitroglycerin i.e. a pre-load reducer which reduces the pressure to go into the heart, whereas Nitroprusside (Nitropress) i.e. afterload reducers cause dilation of the blood vessel and removes the pressure load off your hearts left ventricles.

Ways to prevent pulmonary edema

There is no permanent solution to prevent pulmonary edema. Important is to take proper care of your health i.e. pneumonia vaccination, a flu vaccine (majorly if heart issues or age is old), to continue on diuretics after having pulmonary edema once to avoid it to come on-and-off). Including lifestyle modifications as mentioned below:

Lifestyle Modifications

• A regular visit to the Doctor
• Controlling an increase in blood pressure: Regularly check the blood pressure and taking medications on time. Keep a record for it and check with the doctors for optimal results.
• Controlling other medical issues: To keep a check on your blood sugar levels and taking medications on time.
• Trying to identify the cause of the condition: To avoid further harm to the lung’s identity/rectify the cause and eliminate that.
• Quit Smoking
• Eating a healthy and balanced diet: Consult a Registered Dietitian for a proper diet. Consume healthy and nutritious diet i.e. fruits, vegetables, whole grains, and cereals. Avoid junk foods, processed foods, fried foods, and junk foods.
• Maintain a proper weight, BMI, Waist Circumference, and Exercise

References

1. https://www.ncbi.nlm.nih.gov/books/NBK544260/
2. https://www.nps.org.au/australian-prescriber/articles/managing-acute-pulmonary-oedema
3. https://www.radcliffecardiology.com/articles/pulmonary-oedema-therapeutic-targets
4. https://www.ncbi.nlm.nih.gov/pubmed/7922417