What is Pulmonary Edema?

Pulmonary edema is the medical term for the buildup of fluid in the lungs. It is a condition in which fluid movement occurs into the alveoli (air sacs) of the lungs. This fluid buildup in the lungs makes it difficult for them to function properly, resulting in breathing problems.

Causes of Pulmonary Edema

The most common cause of pulmonary edema (buildup of fluid in the lungs) is congestive heart failure (CHF). Commonly, CHF is a chronic condition in which the heart muscle is too weak to pump blood effectively to meet the body’s demands. The left ventricle (the bottom left portion of the heart) is responsible for pumping oxygen-rich blood throughout the body.

When the heart cannot pump efficiently, blood gets backed up in the blood vessels in the lungs. When the pressure in the blood vessels increases, fluid leaks into the air sacs in the lungs. This buildup of fluid in the lungs leads to hypoxemia (low blood oxygen levels) leading to headache, difficulty breathing, and bluish/pale skin.

Other conditions that can cause pulmonary edema include:

Pneumonia
Exposure to toxins
Medication side effects
Chest wall trauma or injuries
Travel to high altitudes from lower altitude
Pulmonary embolism

Risk Factors for Pulmonary Edema

Besides heart failure, other conditions that can increase the risk of pulmonary edema include:

Cardiac arrhythmias (irregular heart rhythms)
Coronary artery disease
Congenital heart disease
Heart valve disease
Severe hypertension (high blood pressure)
Diabetes
Sleep apnea
Alcohol use
Drug use
Near drowning
Smoke inhalation
Viral illnesses that cause lung damage (hantavirus, dengue fever)
Travel to high altitudes above 2,400 meters or 8,000 feet

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Types of Pulmonary Edema

Acute Pulmonary Edema

Acute pulmonary edema develops suddenly and requires emergency medical care.

Chronic Pulmonary Edema

Chronic pulmonary edema develops slowly over time and causes gradual worsening of breathing difficulties.

Cardiogenic Pulmonary Edema

Cardiogenic pulmonary edema is caused by heart problems such as congestive heart failure, cardiomyopathy, coronary artery disease, problems with the heart valves, arrhythmias, myocarditis, high blood pressure, and kidney disease which can lead to hypertension.

Noncardiogenic Pulmonary Edema

Noncardiogenic pulmonary edema is non-heart-related, such as infections like pneumonia which can cause acute respiratory distress syndrome (ARDS), drug overdose, alcohol use, pulmonary embolism (blood clot in the lungs), near drowning, smoke inhalation, viral illnesses, and injuries related to blood transfusions, and immersion pulmonary edema (also called swimming-induced pulmonary edema from scuba diving or drowning).

Negative pressure pulmonary edema is caused by a blockage in the upper airway. Negative pressure in the lungs results from trying to breathe through this blockage.

Pulmonary edema can also occur due to decreased plasma oncotic pressure in the capillaries (from low protein, low sodium, or sepsis, for example). This can cause fluid to leak out of the capillaries into lung tissue.

Neurogenic Pulmonary Edema

Neurogenic pulmonary edema is caused by damage to the central nervous system, which leads to fluid buildup in the lungs. For example, in people with traumatic brain injuries, spinal cord injuries, intracranial hemorrhage, meningitis, and status epilepticus.

High Altitude Pulmonary Edema

High-altitude pulmonary edema (HAPE) affects people who don’t take enough time to acclimatize— over a few days to weeks—to high altitudes. The symptoms of HAPE often improve upon descent from the high altitude.

Difference between Pulmonary Edema vs Other Conditions

Pulmonary edema is a condition in which too much fluid collects inside the lungs, in the alveoli or air sacs. It is also called the “buildup of fluid in the lungs.”
Pleural effusion is a condition in which fluid collects in the pleura, the membrane covering the lungs. It is also sometimes called “water on the lungs.”
Pulmonary embolism is when blood clots block an artery in the lung, thereby blocking blood flow to a part of the lung. Pulmonary edema can occur if fluid builds up around the clot in the lungs.
Pulmonary hypertension is a condition in which the blood pressure in the lungs is high due to a blockage in the pulmonary artery. Some people also have pulmonary hypertension as a chronic condition.
Pneumonia is an infection of the lungs caused by bacteria, viruses, or fungi. It can progress to pulmonary edema due to the infection causing fluid buildup in the lungs.

Note: Many pulmonary edema signs and symptoms can be similar to those caused by other lung conditions such as pleural effusion, pulmonary emboli, pulmonary hypertension, and pneumonia. It’s important to seek prompt medical care for any respiratory symptoms.

Symptoms of Pulmonary Edema

Common Symptoms of Acute Pulmonary Edema

Dyspnea (difficulty breathing) due to pulmonary congestion from fluid buildup
Wheezing or gasping for breath
Shortness of breath that is worse with physical activity and when supine (lying down)
Feelings of suffocation that are worse with lying down
Cough with a frothy sputum that may be blood-tinged
Palpitations (rapid, irregular heartbeats)
Restlessness, anxiety, or a sense of doom
Cold, clammy skin

Common Symptoms of Chronic Pulmonary Edema

Orthopnea (nighttime breathlessness that is worse with lying down and improves with sitting up in bed)
Shortness of breath with activity and lying down
Wheezing or gasping for breath
New or worsening cough
Tiredness
Swelling in the lower legs and feet
Rapid or unexplained weight gain

Common Symptoms of High-Altitude Pulmonary Edema

Headache (this is typically the first symptom)
Shortness of breath that is worse with activity and improves with rest
Inability to exercise at usual levels
Dry cough that can progress to a cough with frothy sputum that may be blood-tinged (pink)
Tachycardia (fast heartbeat)
Chest pain
Low-grade fever
Weakness
Swelling in extremities, especially fingers

Complications of Untreated Pulmonary Edema

Acute pulmonary edema can be fatal and requires emergency medical attention. Long-term complications of pulmonary edema include:

Difficulty breathing
Swelling in the abdomen, legs, and feet
Pleural effusion (fluid buildup in the membranes surrounding the lungs)
Liver disease due to increased pressure and congestion

How is Pulmonary Edema Diagnosed?

Diagnostic Criteria: How Do Doctors Diagnose Pulmonary Edema?

A healthcare provider can diagnose pulmonary edema based on your symptoms, medical history, physical exam, and test results.

Tests and Procedures Used

Some of the tests your healthcare provider might order to reach a diagnosis of pulmonary edema and identify the cause include:

Chest x-ray
CT (computerized tomography) scan of the chest
Lung ultrasound
Electrocardiogram, a test that records electrical activity in the heart
Echocardiogram, a test that uses sound waves to create images of the heart
Pulse oximetry to measure oxygen levels in the blood
Arterial blood gas to measure oxygen and carbon dioxide levels in blood
B-type natriuretic peptide (BNP) blood test (elevated levels can indicate a heart condition)
Other blood tests like complete blood count, metabolic panel, kidney function tests, and thyroid function tests
Cardiac catheterization and coronary angiogram to look for blockages in the arteries that supply blood to the heart
Pulmonary artery catheterization to differentiate between cardiogenic pulmonary edema and noncardiogenic pulmonary edema

Differential Diagnosis

Some of the other conditions that share the same or similar symptoms as pulmonary edema include:

Acute respiratory distress syndrome (ARDS)
Respiratory failure
Myocardial infarction (heart attack)
Pulmonary embolism
Drug overdose from salicylates or opioids

How is Pulmonary Edema Treated?

Acute Management

Immediate management of pulmonary edema symptoms mainly involves the use of supplementary oxygen to ease symptoms. Oxygen as a respiratory medicine can be delivered through a face mask or nasal cannula. Sometimes, mechanical ventilation (use of a breathing machine) is necessary.

Treatment for high-altitude pulmonary edema (HAPE) includes oxygen therapy, moving to a lower elevation, or the use of a portable hyperbaric chamber until transfer to a lower elevation is possible.

Medications and Interventions

Medication management of pulmonary edema may involve the following medications:

Diuretics (water pills) such as furosemide (Lasix) to remove excess fluid from the body are the mainstay of treatment. These medications are administered intravenously for acute pulmonary edema.
Blood pressure medicines (vasodilator or vasoconstrictor) to manage high or low blood pressure.
Cardiac medications, such as nitroglycerin (Nitrostat, others), sodium nitroprusside (Nitropress), and isosorbide dinitrate.
Inotropes (given intravenously in a hospital setting) to help the heart muscle contract with more power in people with severe heart failure. Examples include epinephrine, norepinephrine, digoxin (Lanoxin), and others.
Opioid medications such as morphine (MS Contin, others) to relieve anxiety related to shortness of breath and reduce breathing rate. Together, these two mechanisms help patients to relax and catch their breath.

Long-Term Management Strategies

Your doctor will manage other chronic health conditions that can cause or increase the risk of pulmonary edema, such as heart failure, high blood pressure, and diabetes.
Your healthcare provider will recommend that you avoid the cause of pulmonary edema, such as alcohol or drug use, or travel to high-altitude destinations.

Prognosis and Outlook for Pulmonary Edema Patients

Survival Rates and Outcomes: What Are The Odds of Surviving Pulmonary Edema?

Pulmonary edema is a life-threatening condition. Your odds of surviving it depend on what caused it. One year after discharge from the hospital about 50% of patients survive pulmonary edema due to cardiac causes. In-hospital mortality rates for patients admitted with pulmonary edema are about 17%.

As noted, the survival rate in patients with pulmonary edema depends on the underlying cause. Studies suggest the following:

The mortality rate is 85% at 6 years follow-up in patients with congestive heart failure, which is the main cause of pulmonary edema.
Severe ARDS is linked to a 40% mortality rate.
Neurogenic pulmonary edema occurs in 71% of people with intracranial hemorrhage. The prognosis is particularly poor in patients with this type of pulmonary edema which occurs due to damage to the central nervous system.
Death rates from transfusion-related acute lung injury are 5-10% but can be up to 47% in severely ill patients.

Influencing Factors: What Is The Prognosis for Pulmonary Edema?

Factors that can influence the prognosis (outcome) in patients with acute pulmonary edema include underlying causes such as worsening congestive heart failure, blockages in the coronary arteries supplying the heart, heart attack, and cardiac arrhythmias. In addition, noncompliance with prescribed treatments can lead to worse outcomes.

Follow-Up Care and Monitoring: Does Pulmonary Edema Go Away On Its Own?

No, pulmonary edema does not go away on its own. You need to seek proper diagnosis and timely medical treatment for the underlying cause of fluid in your lungs. Follow your doctor’s advice for ongoing care and monitoring to manage the condition.

Prevention and Lifestyle Modifications: How to Prevent Pulmonary Edema?

Preventive Measures for High-Altitude Pulmonary Edema (HAPE)

If you are traveling to high altitudes above 2,500 meters or 8,000 feet, experts recommend that you ascend gradually (no more than 300-360 meters or 1,000-2,000 feet per day) to prevent HAPE.

Talk to your healthcare provider about taking prescription medications such as acetazolamide (Diamox) or nifedipine (Procardia), starting one day before your ascent, to prevent HAPE.

Lifestyle Changes to Reduce Risk: What Is The Best Thing To Do for Pulmonary Edema?

You can lower your risk of heart and lung problems by following a healthy lifestyle:

Eat a balanced heart-healthy diet
Get regular physical activity
Maintain a healthy body weight
Limit salt intake
Limit alcohol intake
Avoid smoking
Manage stress

Importance of Early Detection and When to Seek Medical Help

Acute pulmonary edema or an acute exacerbation (worsening) of chronic pulmonary edema can be life-threatening and potentially fatal. Call 911 if you develop the following symptoms:

Sudden worsening of pulmonary edema symptoms
Sudden dyspnea (shortness of breath or trouble breathing)
Feeling of suffocation
Wheezing or gasping for breath
Coughing up blood-tinged phlegm or sputum
Excessive sweating accompanying breathing difficulties
Cyanosis (blue or gray tinge to the skin)
Low blood pressure (dizziness, lightheadedness, sweating, weakness)
Confusion

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