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15 / 12 / 2017
Pulmonary Edema
 
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Pulmonary edema

 
ASTHMA & RESPIRATORY SYSTEM

Respiratory System

 

Pulmonary edema is a medical emergency and requires immediate care. Although it can sometimes prove fatal, the outlook is often good when you receive prompt treatment along with therapy for the underlying problem.

Your lungs contain millions of small, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide, a waste product of metabolism. Normally, the exchange of oxygen and carbon dioxide takes place without problems. But sometimes increased pressure in the blood vessels in your lungs forces fluid into the air sacs, filling your lungs with fluid and preventing them from absorbing oxygen - a condition called pulmonary edema.

In most cases, heart problems are the cause of pulmonary edema. But fluid can accumulate in your lungs for other reasons, including lung problems such as pneumonia, exposure to certain toxins and medications, and climbing or living at high altitudes.

Signs and symptoms

Depending on the cause, the signs and symptoms of pulmonary edema may appear suddenly or develop slowly over weeks or months. Signs and symptoms that develop over time may include:

  • Difficulty breathing when you're lying flat as opposed to sitting up.

  • Awakening at night with a breathless feeling.

  • Having more shortness of breath than normal when you're physically active.

  • Significant weight gain when pulmonary edema develops as a result of congestive heart failure, a condition in which your heart pumps too little blood to meet your body's needs. This causes fluid to accumulate in your tissues.

Signs and symptoms that come on suddenly are usually severe and may include:

  • Extreme shortness of breath or difficulty breathing

  • A feeling of suffocating or drowning

  • Wheezing or grunting sounds when breathing

  • Anxiety and restlessness

  • A cough that produces frothy, pink sputum

  • Excessive sweating

  • Pale skin

If you develop any of these signs or symptoms, call for emergency medical assistance right away. Pulmonary edema can be fatal if not treated.

Causes

Your lungs are two spongy organs surrounded by a moist membrane (the pleura). Stretched out, they would cover about 100 square yards — the size of a badminton court. Although your lungs can hold up to 4 quarts of air, you generally inhale only about a pint of air with each breath.

Two major airways (bronchi) carry air into your lungs. These airways subdivide into smaller airways (bronchioles) that finally end in clusters of tiny air sacs. Your lungs have about 300 million of these air sac clusters, which inflate like miniature balloons every time you inhale.

Wrapped around each air sac are tiny 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.

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.

How your heart works
Your heart is composed of two upper and two lower chambers. The upper chambers (the right and left atria) receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves — which keep blood flowing in the right direction — are gates at the chamber openings.

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, 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.

Cardiac pulmonary edema — also known as congestive heart failure — occurs when the left ventricle isn't able to pump out enough of the blood it receives from your lungs. As a result, pressure increases inside the left atrium and then in the pulmonary veins and capillaries, causing fluid to be pushed through the capillary walls into the air sacs.

Several medical conditions can cause the left ventricle to become weak or to fail, including:

  • Coronary artery disease. Over time, the arteries that supply blood to your heart (coronary arteries) 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 the 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 the heart suddenly weakens, fluid backs up into your lungs.

  • Cardiomyopathy. When your heart muscle is damaged by causes other than blood flow problems, the condition is called cardiomyopathy. Often, cardiomyopathy has no known cause, although it sometimes runs in families. Less common causes include infections (myocarditis), alcohol abuse and the toxic effects of drugs such as cocaine and some types of chemotherapy. Because cardiomyopathy weakens the left ventricle — your heart's main pump — it 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 (mitral or aortic heart valve disease). In mitral or aortic valve disease, the valves that regulate blood flow either don't open wide enough (stenosis) or don't close completely(aortic or mitral valve 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 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 because of the snapping of the valve cord, 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.

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 the body, where it can cause leg swelling (edema), abdominal swelling (ascites) or a buildup of fluid in the pleural space (pleural effusion).

Noncardiac pulmonary edema
Not all pulmonary edema is the result of heart disease. Fluid may also leak from the capillaries in your lungs' air sacs because the capillaries themselves become more permeable or leaky, even without the buildup of back pressure from your heart. In that case, the condition is known as noncardiac pulmonary edema because your heart isn't the cause of the problem. Some factors that can cause increased capillary permeability leading to noncardiac pulmonary edema are:

  • 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 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).

  • Severe allergic reactions (anaphylaxis). You can have serious allergic reactions to some medications as well as to certain foods and insect venom.

  • Smoke inhalation. Children and older adults are especially vulnerable to lung damage caused by breathing harmful vapors and gases in smoke from structural fires. The smoke from these fires often contains chemicals that irritate the lining of the lungs, causing the tiny blood vessels to leak.

  • Near-drowning and drowning.

  • Drug overdose. Drugs ranging from narcotics, such as heroin, to aspirin can cause noncardiac pulmonary edema. Aspirin-induced pulmonary edema can occur in people who take increasingly large doses of aspirin to relieve pain or other symptoms. For reasons that aren't clear, smokers who use aspirin are at greater risk.

  • Acute respiratory distress syndrome (ARDS). This serious disorder, which affects hundreds of thousands of people every year, occurs when your lungs suddenly become unable to take in enough oxygen. More than 30 conditions can cause ARDS, including severe injuries (trauma), systemic infection (sepsis), pneumonia or shock. ARDS sometimes also develops after extensive surgery. Symptoms usually appear within 24 to 72 hours after the original illness or trauma.

  • 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 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. Although the exact mechanism isn't completely understood, HAPE seems to develop as a result of increased pressure from constriction of the pulmonary capillaries. Symptoms include headaches, insomnia, fluid retention, cough and shortness of breath. Without appropriate care, HAPE can be fatal.

When to seek medical advice

Pulmonary edema is life-threatening. Get emergency assistance if you have any of the following acute signs and symptoms:

  • Trouble breathing or a feeling of suffocating (dyspnea)

  • A bubbly, wheezing or grunting sound when you breathe

  • Pink, frothy sputum when you cough

  • Profuse sweating

  • Light-headedness

  • A blue or gray tone to your skin

  • A severe drop in blood pressure

Acute pulmonary edema is likely to be incapacitating, so don't attempt to drive yourself to the hospital. Instead, dial  emergency medical care and wait for help.

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