Pulmonary Edema, Causes, Diagnosis, Treatment, Prevention, Complications

Pulmonary edema is a condition characterized by symptoms of difficulty breathing due to fluid buildup in the alveoli. Pulmonary edema is divided into acute pulmonary edema, chronic pulmonary edema, and high-altitude pulmonary edema (HAPE).

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Pulmonary Edema, Causes, Diagnosis, Treatment, Prevention, Complications

Pulmonary edema is more common in elderly people. This condition is experienced by 1 in 15 people aged 75–84 years, and 1 in 7 people aged 85 years and over with heart failure.

Causes of Pulmonary Edema

The causes of pulmonary edema are categorized into 2 groups, namely pulmonary edema associated with heart problems (cardiogenic pulmonary edema) and pulmonary edema that occurs without cardiac disorders (noncardiogenic pulmonary edema).

Normally, the heart pumps blood around the body from a part of the heart called the left ventricle. The blood pumped from the left ventricle is blood from the lungs which contains oxygen.

Pulmonary edema caused by heart problems generally occurs because the left ventricle is unable to pump blood out of the heart maximally. As a result, blood remains in the left ventricle and causes an increase in pressure.

Increased pressure in the left ventricle will make it more difficult for blood from the lungs to enter the heart, so that the blood will pool in the pulmonary veins. If the pressure in the blood vessels of the lungs is too high, some of the fluid from the blood vessels will be pushed out and into the alveoli.

The following are some disorders of the heart that can cause pulmonary edema:

Coronary heart disease
Hypertension
Cardiomyopathy
Heart valve disease

Meanwhile, non-cardiogenic pulmonary edema can be caused by various conditions, including:

Acute respiratory distress syndrome
Viral infections, including COVID-19
Pulmonary embolism
Injury to the lungs
Sink
Being at altitude (above 2,400 meters above sea level)
Head injury or seizures
Complications from brain surgery
Inhaling smoke during a fire
Exposure to poisons, such as ammonia and chlorine
Reactions to some medications, including aspirin

Pulmonary Edema Risk Factors

Several factors that can increase a person's risk of developing pulmonary edema are:

Have heart problems or heart failure
Have had pulmonary edema before
Have a lung disease, such as tuberculosis or chronic obstructive pulmonary disease (COPD)
Have blood vessel disorders

Pulmonary Edema Symptoms

A common symptom experienced as a result of suffering from pulmonary edema is difficulty breathing. However, other symptoms that arise can be slightly different for each person, depending on the type of pulmonary edema suffered.

In acute edema, symptoms that can occur include:

Sudden shortness of breath, especially after exertion or when lying down
Feeling like you are drowning or your heart is pounding
Nervous
Difficulty breathing with profuse sweating
Makes unusual breathing sounds, such as rough breathing, wheezing, or gasping
Coughing up phlegm that is frothy and mixed with blood
Skin that is cold and clammy or looks pale or bluish
Fast and irregular heartbeat (palpitations)
Feeling dizzy, weak, or sweaty

Meanwhile, in chronic pulmonary edema, symptoms that may be experienced include:

Get tired more easily
Weight increases rapidly
Breathing becomes heavier than usual, especially with activity and lying down
Swelling in both legs
Wheezing
Often wakes up at night due to shortness of breath

High-altitude pulmonary edema (HAPE) can occur when sufferers travel or exercise at very high altitudes. Signs and symptoms that may appear include:

Headache
Shortness of breath after exertion, progressing to shortness of breath at rest
Dry cough, which continues into a cough with frothy phlegm mixed with blood
Difficulty walking uphill, which progresses to difficulty walking on level ground
Fever
Weak
Chest pain
rapid heartbeat

When to see a doctor

Immediately go to the doctor or emergency room if you experience symptoms of acute pulmonary edema, HAPE pulmonary edema, or chronic pulmonary edema as mentioned above.

Don't drive yourself to the hospital. It is better to call an ambulance or medical personnel for help.

If you see someone having an attack of acute pulmonary edema, rush them to the hospital or call an ambulance. Tell the doctor the symptoms the patient is experiencing so that the doctor can provide the right help.

Routine check-ups may be recommended if you are at high risk of developing pulmonary edema, to prevent the condition from becoming severe.

Diagnosis of Pulmonary Edema

To diagnose pulmonary edema, the doctor will ask questions about the symptoms experienced and the patient's medical history, especially if the patient has had heart or lung disease.

Next, the doctor will perform a physical examination by checking the heartbeat and sounds from the lungs using a stethoscope. If needed, the doctor can also carry out a number of supporting examinations, such as:

Pulse oximetry, to quickly measure the level of oxygen in the blood, by placing a sensor on the finger or toe
Electrocardiogram (EKG), to see any problems with heart rhythm, an overview of heart muscle function, and the possibility of coronary heart disease
Chest X-ray, to ensure that the patient really has pulmonary edema, and to see other possible causes of shortness of breath
Blood tests, to measure the levels of oxygen and carbon dioxide in the blood (blood gas analysis), measure levels of the hormone B-type natriuretic peptide (BNP) which are elevated in heart failure, and look at thyroid and kidney function
Echocardiography, to detect problems with the pumping function of the heart
Cardiac catheterization, used to measure the pressure in the heart chambers, evaluate the work of the heart valves, and check the smooth flow of blood in the coronary vessels of the heart

Pulmonary Edema Treatment

As the first treatment for pulmonary edema, the patient will be given oxygen. Oxygen is given through a face mask or a small tube placed in the nose.

Based on the conditions and causes of pulmonary edema, the doctor may also prescribe one or more of the following medicines:
Diuretics, such as furosemide, to reduce pressure caused by excess fluid in the heart and lungs
Blood pressure medication, to control high blood pressure or raise blood pressure that is too low
Nitrate class of drugs, such as nitroglycerin, to dilate blood vessels and reduce the pressure load on the left ventricle of the heart

Most pulmonary edema conditions require treatment in the emergency room or in the intensive care unit (ICU). If necessary, the patient will be attached to a tube connected to a respirator to ensure that sufficient oxygen enters the body.

Pulmonary Edema Complications

Untreated pulmonary edema can cause increased pressure in the right heart chamber, which functions to receive blood from all over the body. This condition can cause the right heart chambers to fail and cause:

Fluid buildup in the abdominal cavity (ascites)
Swelling of the limbs
Swelling of the liver

Prevention of Pulmonary Edema

The risk of developing pulmonary edema can be reduced by taking the following simple steps:

Do regular exercise, 30 minutes every day.
Consume healthy foods in the form of vegetables, fruits, and foods low in fat, sugar and salt. It aims to maintain body weight, blood cholesterol levels, and blood pressure within limits
Do not smoke.
Manage stress well.

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