Pulmonary Edema
Pulmonary Edema
Definition
Your lungs contain millions of small, elastic air sacs. With each breath, the air sacs
take in oxygen and release carbon dioxide. Normally, the exchange of gases takes
place without problems. But sometimes increased pressure in the blood vessels in
your lungs forces fluid into the air sacs, preventing them from absorbing oxygen — a
condition called pulmonary edema.
In most cases, heart problems cause pulmonary edema. But fluid can accumulate for
other reasons, including pneumonia, exposure to certain toxins and medications, and
exercising or living at high elevations.
Symptoms
Depending on the cause, pulmonary edema symptoms may appear suddenly or
develop slowly over weeks or months.
Signs and symptoms that come on suddenly are usually severe and may include:
If you develop any of these signs or symptoms, call 911 or emergency medical
assistance right away. Pulmonary edema can be fatal if not treated.
Wrapped around each air sac are capillaries that connect the arteries and veins in your
lungs. The capillaries are so narrow that red blood cells have to pass through them in
single file. Each red blood cell absorbs oxygen, while the plasma — the fluid
containing the red blood cells — releases carbon dioxide as well as absorbs some of
the oxygen.
But in certain circumstances, the alveoli fill with fluid instead of air, preventing
oxygen from being absorbed into your bloodstream. A number of factors can cause
fluid to accumulate in your lungs, but most have to do with your heart (cardiac
pulmonary edema). Understanding the relationship between your heart and lungs can
help explain why.
Normally, deoxygenated blood from your body enters the right atrium and flows into
the right ventricle, where it's pumped through large blood vessels (pulmonary arteries)
to your lungs. There, the blood releases carbon dioxide and picks up oxygen. The
oxygen-rich blood then returns to the left atrium through the pulmonary veins, flows
through the mitral valve into the left ventricle, and finally leaves your heart through
another large artery, the aorta. The aortic valve at the base of the aorta keeps the blood
from flowing backward into your heart. From the aorta, the blood travels to the rest of
your body.
Congestive heart failure can also occur when the right ventricle is unable to overcome
increased pressure in the pulmonary artery, which usually results from left heart
failure, chronic lung disease or high blood pressure in the pulmonary artery
(pulmonary hypertension).
Medical conditions that can cause the left ventricle to become weak and eventually
fail include:
Coronary artery disease. Over time, the arteries that supply blood to your
heart can become narrow from fatty deposits (plaques). A heart attack occurs
when a blood clot forms in one of these narrowed arteries, blocking blood
flow and damaging the portion of your heart muscle supplied by that artery.
The result is that the damaged heart muscle can no longer pump as well as it
should.
Although the rest of your heart tries to compensate for this loss, it's either
unable to do so effectively or it's weakened by the extra workload. When the
pumping action of your heart is weakened, blood backs up into your lungs,
forcing fluid in your blood to pass through the capillary walls into the air sacs.
Because cardiomyopathy weakens the left ventricle — your heart's main pump
— your heart may not be able to respond to conditions that require it to work
harder, such as a surge in blood pressure or infections. When the left ventricle
can't keep up with the demands placed on it, fluid backs up into your lungs.
Heart valve problems. In mitral valve disease or aortic valve disease, the
valves that regulate blood flow either don't open wide enough (stenosis) or
don't close completely (insufficiency). This allows blood to flow backward
through the valve. When the valves are narrowed, blood can't flow freely into
your heart and pressure in the left ventricle builds up, causing the left ventricle
to work harder and harder with each contraction.
The increased pressure extends into the left atrium and then to the pulmonary
veins, causing fluid to accumulate in your lungs. On the other hand, if the
mitral valve leaks, some blood is backwashed toward your lung each time
your heart pumps. If the leakage develops suddenly, you may develop sudden
and severe pulmonary edema.
High blood pressure (hypertension). Untreated or uncontrolled high blood pressure causes a
thickening of the left ventricular muscle, and accelerates coronary artery disease.
Lung infections. When pulmonary edema results from lung infections, such as pneumonia,
the edema occurs only in the part of your lung that's inflamed.
Exposure to certain toxins. These include toxins you inhale — such as chlorine, ammonia
or nitrogen dioxide — as well as those that may circulate within your own body. For
example, women giving birth may develop pulmonary edema when amniotic fluid reaches
the lungs through the veins of the uterus (amniotic fluid embolism).
Kidney disease. When your kidneys can't remove waste effectively, excess fluid can build
up, causing pulmonary edema.
Smoke inhalation. Smoke contains chemicals that damage the membrane between the air
sacs and the capillaries, allowing fluid to enter your lungs.
Adverse drug reaction. Many drugs — ranging from narcotics such as heroin to diabetes
medications and chemotherapy drugs — are known to cause noncardiac pulmonary edema.
Acute respiratory distress syndrome (ARDS). This serious disorder occurs when your lungs
suddenly fill with fluid and inflammatory blood cells. Many conditions can cause ARDS,
including severe injuries (trauma), systemic infection (sepsis), pneumonia and shock.
ARDS sometimes develops after extensive surgery.
High altitudes. Mountain climbers and people who live in or travel to high-
altitude locations run the risk of developing high-altitude pulmonary edema
(HAPE). This condition — which typically occurs at elevations above 8,000
feet — can also affect hikers or skiers who start exercising at higher altitudes
without first becoming acclimated. But even people who have hiked or skied
at high altitudes in the past aren't immune.
Once your condition is more stable, your doctor will ask about your medical history,
especially whether you have ever had cardiovascular or lung disease. You'll also
likely have a chest X-ray, which can help support a diagnosis of pulmonary edema.
And you may have further tests to determine why you developed fluid in your lungs.
These tests may include:
The test can help diagnose a number of heart problems, including valve
problems, abnormal motions of the ventricular walls, fluid around the heart
(pericardial effusion) and congenital heart defects. It also accurately measures
the amount of blood your left ventricle ejects with each heartbeat (ejection
fraction, or EF). Although a low EF often indicates a cardiac cause for
pulmonary edema, it's possible to have cardiac pulmonary edema with a
normal EF.
Complications
If pulmonary edema persists, it can raise pressure in the pulmonary artery and
eventually the right ventricle begins to fail. The right ventricle has a much thinner
wall of muscle than does the left side. The increased pressure backs up into the right
atrium and then into various parts of your body, where it can cause:
Depending on your condition and the reason for your pulmonary edema, you may also
receive one or more of the following medications:
Sometimes, however, immediate rescue isn't possible. With this in mind, researchers
have devised several experimental therapies. In one, the distressed climber is placed
in an airtight bag known as a hyperbaric bag, which is then pumped with air,
simulating the air pressure at a lower altitude. A night's sleep in the bag seems to
relieve symptoms — at least temporarily.
Some climbers take the prescription medication acetazolamide (Diamox) to help treat
or prevent symptoms of HAPE. Diamox can occasionally have side effects —
including tingling or burning in the hands, feet and mouth, confusion, diarrhea,
nausea, and thirst.
Nursing Care
• Administer prescribed medications;
morphine, diuretics, …
• Bed rest
• Put the patient in upright position
• Check vital signs frequently
• Monitor intake and output
• Decrease anxiety
Prevention
Pulmonary edema often isn't preventable, but these measures can help reduce your
risk:
Control your blood pressure. High blood pressure (hypertension) can lead to
serious conditions such as stroke, cardiovascular disease and kidney failure.
Most adults should have their blood pressure checked at least once every two
years. This is a noninvasive and painless procedure using an inflatable cuff
that wraps around your upper arm. The test takes just a few minutes.
Preventing HAPE
If you travel or climb at high altitudes, acclimate yourself slowly. Although
recommendations vary, most experts advise ascending no more than 1,000 or 2,000
feet a day once you reach 8,000 feet. In addition, it's important to drink plenty of
water to stay hydrated. The higher you ascend the more rapidly you breathe, which
means you lose larger amounts of water in the air you exhale from your lungs.
Finally, although being physically fit won't necessarily prevent HAPE, people in good
condition tend to be less stressed at high altitudes.
Get plenty of sleep each night. Take a nap during the day if you feel tired.
Listen to medical advice. Follow your doctor's advice about controlling any
underlying health problems, including advice about diet and exercise.
Try to get at least 30 minutes of exercise on most days. If your exercise
plan seems too hard or too easy, talk to your doctor or a rehabilitation
therapist.
Weigh yourself daily. Do so in the morning before breakfast and keep a
record of your daily weight. Call your doctor if you've gained 2 to 3 pounds in
a single day.
Avoid drinking alcohol.Your lungs and heart work harder when you drink
alcohol.