Pulmonary edema

Alternative names
Lung/pulmonary congestion; Lung water

Definition
Pulmonary edema involves fluid accumulation and swelling in the lungs.

Causes, incidence, and risk factors

Pulmonary edema is usually caused by heart failure that results in increased pressure in the pulmonary (lung) veins. However, problems within the lungs themselves can also result in fluid accumulation.

Pulmonary edema can be a complication of a heart attack, leaking or narrowed heart valves (mitral or aortic valves), or any disease of the heart that either results in weakening and/or stiffening of the heart muscle (cardiomyopathy). The failing heart transmits its increased pressure to the lung veins. As pressure in the lung veins rises, fluid is pushed into the air spaces (alveoli). This fluid then becomes a barrier to normal oxygen exchange, resulting in shortness of breath.

Pulmonary edema can also be caused by direct lung injury from toxins including heat and poisonous gas, severe infection, or an excess of body fluid as seen in kidney failure.

Symptoms

     
  • Shortness of breath  
  • Difficulty breathing  
  • Feeling of “air hunger” or “drowning”  
  • Grunting or gurgling sounds with breathing  
  • Wheezing  
  • Shortness of breath with lying down, causing the patient to sleep with head propped up or using extra pillows  
  • Cough  
  • Anxiety  
  • Restlessness  
  • Excessive sweating  
  • Pale skin

Additional symptoms that may be associated with this disease:

     
  • Nasal flaring  
  • Coughing up blood  
  • Inability to speak from air hunger  
  • Decrease in level of awareness

Signs and tests

During a physical exam, the provider may identify the following signs:

     
  • Rapid breathing and increased heart rate  
  • Crackles in the lungs or abnormal heart sounds (while listening to the chest with a stethoscope)  
  • Pale or blue skin color

Possible tests include:

     
  • Blood oxygen levels (low)  
  • A chest x-ray may reveal fluid in or around the lung space or an enlarged heart  
  • An ultrasound of the heart (echocardiogram) may reveal weak heart muscle, leaking or narrow heart valves, or fluid surrounding the heart

Treatment

Oxygen is given via nasal prongs or a face mask. Intubation (breathing tube placed into the windpipe) and use of a breathing machine (ventilator) may be needed.

Underlying causes must be rapidly identified and treated. For example, if a heart attack has caused the condition, the heart must be treated and stabilized.

Medications to accelerate water excretion from the body via the urine (diuretics) are given. One common diuretic is furosemide (Lasix). Other medications to strengthen the heart muscle or to relieve the pressure on the heart may also be given as needed.

Expectations (prognosis)
Although pulmonary edema can be a life-threatening condition, it is often readily treatable. Prognosis, however, depends upon the underlying disease.

Complications

The patient may require long-term dependence on a breathing machine (ventilator).

Calling your health care provider

Go to the emergency room or call 911 if conditions suggesting pulmonary edema occur, particularly if breathing is difficult.

Prevention
In patients with known diseases that can lead to pulmonary edema, strict compliance with taking medications in a timely manner and following an appropriate diet (usually, low in salt) can significantly decrease one’s risk.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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