Pulmonary Edema

What is pulmonary edema?

• Pulmonary edema is a buildup of fluid in the alveoli (air sacs) of your lungs. Your lungs are organs in your chest that fill with oxygen when you breathe in. Air enters your lungs through your airways (tubes) until it reaches tiny sacs called alveoli. Your alveoli then take the oxygen from the air and send it to your blood. The alveoli also exchange (trade) the oxygen for carbon dioxide (unoxygenated gas). You are then able to breathe the carbon dioxide out of your body.
  
  
• When you have pulmonary edema, the fluid in the alveoli makes it hard for the alveoli to fill with air. This can make it harder for you to breathe and may decrease the oxygen in your blood. If your body cannot get enough oxygen, your tissues and organs may not work as they should. Treating your pulmonary edema may help decrease the fluid in your alveoli. This may help your lungs work normally, allowing your body to get the oxygen it needs to function properly.

What causes pulmonary edema?

Pulmonary edema can occur when fluid is pushed out of the blood vessels and into the alveoli. This can happen when increased pressure in the blood vessels forces the blood and fluid backwards. An example of this is when a weak heart cannot pump blood forward as it should. This is called increased pressure pulmonary edema or cardiogenic pulmonary edema. Pulmonary edema can also occur when your lung cells are damaged. With damage, fluid leaks into the alveoli through small openings in the lung cells. This is called increased permeability edema or noncardiogenic pulmonary edema. There are many health conditions and other factors that can increase your risk for pulmonary edema. Ask your caregiver for more information about these and other risk factors for pulmonary edema:

• Heart failure: With heart failure, your heart cannot pump as it should. When this occurs, fluid may build up in your body and lungs, leading to pulmonary edema.
  
  
• Lung infection or injury: An infection, such as pneumonia (lung infection) may lead to pulmonary edema. You may also get pulmonary edema if your lung is injured. A lung injury can occur from an accident or trauma, breathing in chemicals or gases, and burns. You can also get a lung injury if you are on a ventilator (breathing machine) for a long period of time. A breathing machine forces air into your lungs, which increases the pressure in your lungs. Laryngospasm from putting in or taking out a breathing tube can also lead to pulmonary edema. A laryngospasm is when the muscles in your throat tighten.
  
  
• Heart conditions: Having abnormal heartbeats or damage to a heart valve increases your risk for pulmonary edema. You are also at risk if you have a heart attack.
  
  
• High altitude: Travelling to high altitudes (heights), such as in the mountains, can lead to high altitude pulmonary edema (HAPE). This normally occurs when your body is not used to high altitudes and you climb up too quickly. HAPE may occur when you travel up to, and higher than, 2,500 to 3,000 meters.
  
  
• Thoracentesis: If you have fluid in the sac surrounding the lungs, you may need a thoracentesis. This is a procedure to remove fluid from around your lung. When the fluid is removed and your lung is able to fill with air, you may get pulmonary edema.
  
  
• Blood transfusion: When you get a transfusion of blood or parts of blood, you may be at risk for pulmonary edema. This can occur if you have a transfusion-related lung injury from a reaction to the blood product. The reaction may cause fluid to enter your alveoli. Your body may also become overloaded (too much) with fluid from the transfusion, causing fluid to collect in your alveoli.
  
  
• Blocked airway: If your airway becomes blocked, it can be hard for you to breathe. Pressure changes inside your chest and lungs causes fluid to enter your alveoli.
  
  
• Medicines and illegal street drugs: Certain medicines, such as those used to treat inflammation (swelling), can lead to pulmonary edema. Ask your caregiver about medicines that may increase your risk. Illegal street drugs, such as heroin and cocaine, also increase your risk.

What are the signs and symptoms of pulmonary edema?

You may have any of the following:

• Trouble breathing, with or without activity. You may have more trouble breathing when lying down. You may also hear wheezing (a high-pitched noise when breathing), and you may breathe faster than normal.
  
  
• Chest discomfort or heaviness.
  
  
• A cough. You may cough up pink, foamy sputum (spit).
  
  
• Fatigue (tiredness) and feeling the need to rest often.
  
  
• Pale (lighter color than normal) skin, or bluish nail beds and lips.
  
  
• Sweating for no known reason. Your heart may beat faster than it normally does.
  
  
• Anxiety (nervousness).

How is pulmonary edema diagnosed?

Your caregiver will ask about your signs and symptoms. Tell your caregiver about any medical problems you have, or have had. Your caregiver will do a physical exam including listening to your lungs with a stethoscope. Your caregiver will listen for abnormal breathing noises that may occur with pulmonary edema. He will also check your blood pressure to see if it is higher than it should be. You may also need the following tests:

• Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Chest x-ray: A chest x-ray is a picture of your lungs and heart. A chest x-ray may show fluid in or around the lungs and heart. Caregivers may also use it to look for signs of infection, such as pneumonia.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Transthoracic echocardiogram: This test is also called an echo. It is a type of ultrasound done to show pictures of the size and shape of your heart. Caregivers may check for problems with your heart valves and signs of heart failure. This may be done to find the cause of your pulmonary edema.
  
  
• Cardiac catheterization: This is a test to see how well your heart is working. This test may also check the pressure in your arteries (blood vessels). This test may help caregivers learn the cause of your pulmonary edema. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.

How is pulmonary edema treated?

Treatments will depend on what caused your pulmonary edema. If high altitude caused your pulmonary edema, going to a lower altitude may resolve your symptoms. Your caregiver may have you rest in bed until your breathing gets better. You may also need any of the following:

• Medicines:
  
  
  • Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
    
    
  • Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. Others may help to lower your blood pressure. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
    
    
  • Vasodilators: Vasodilators may improve blood flow by making the blood vessels in your heart and lungs wider. This may decrease the pressure in your blood vessels and improve your symptoms.
  
  
• Breathing assist: You may need the following treatments if you are not getting enough oxygen on your own:
  
  
  • Oxygen: You may need oxygen to help you breathe better and decrease the pressure in your lungs. You may get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose.
    
    
  • Noninvasive positive-pressure ventilation: Noninvasive positive-pressure ventilation (NPPV) may be needed to help you breathe better. A machine helps your lungs fill with air through a mask or a mouthpiece. If a mask is used, it may go over your nose and mouth, or just your nose. Extra oxygen may also be given to you through the machine.
    
    
  • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal (ET) tube in your mouth or nose. The ET tube is hooked to the ventilator. The ventilator can also give oxygen to you.

What are the risks of having pulmonary edema?

• Medicines used to treat your pulmonary edema may cause dizziness, headaches, low blood pressure, and kidney problems. The levels of potassium in your blood may change and lead to abnormal heartbeats. Your heart may beat too quickly or too slowly. If you are wearing an oxygen mask, it may be uncomfortable and you may have trouble talking. Your nose or the skin on your face may get dry, sore, and red. If you need an ET tube and ventilator to breathe, your throat may be injured when the ET tube is put in. You will not be able to speak or eat while the ET tube is in place. You may also get a lung or sinus infection and your heartbeat may become irregular.
  
  
• Pulmonary edema can be a serious, life-threatening condition. Without treatment, your symptoms, such as trouble breathing and chest discomfort, may get worse. You may get more tired from a lack of oxygen, and you may go into a coma. A coma is when you look like you are sleeping but cannot be woken. Your heart may not pump as it should, and your body may not get the oxygen it needs to function. If you do not get treatment for your pulmonary edema, you may die. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

How can I help manage my pulmonary edema and prevent it from happening again?

• Climb to high altitudes slowly: Make sure you take your time to allow your body to get used to the new altitude. If you are climbing to high altitudes with no emergency care, ask your caregiver about the signs and symptoms of HAPE. Ask your caregiver what you should do if you get symptoms of HAPE.
  
  
• Do not smoke or take illegal drugs: If you smoke, it is never too late to quit. Smoking harms your body in many ways. Smoking can worsen your pulmonary edema and cause other lung disease, heart disease, and cancer. Quitting smoking will improve your health and the health of those around you. Ask your caregiver for more information about how to stop smoking if you smoke and are having trouble quitting. Do not take any illegal street drugs, such as cocaine. Street drugs can make your condition and symptoms worse.
  
  
• Eat a healthy diet: You may need to change the way you eat to help control your symptoms. Foods low in salt are best. You should eat a variety of healthy foods from each food group every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
  
  
• Limit or avoid alcohol: You will need to limit the alcohol you drink, or avoid alcohol completely. Drinking too much alcohol can damage your brain, heart, and liver. Drinking too much alcohol can worsen your symptoms and increase your blood pressure. If you have heart failure, alcohol can make it worse. Alcohol is found in beer, wine, whiskey, and other adult drinks.
  
  
• Limit your liquids as directed by your caregiver: Follow your caregiver’s advice about how much liquid you should drink each day. Drinking too much liquid can increase your risk for fluid buildup.
  
  
• Maintain a healthy weight: Maintain a healthy weight so your heart does not have to work so hard. If you are overweight (weighing more than caregivers suggest), ask your caregiver about a healthy weight-loss plan. Your caregiver may suggest you weigh yourself at the same time every morning. Weight gain can be a sign of extra fluid in your body. It is best to weigh yourself on the same scale, before eating, and after urinating.
  
  
• Take your medicines as instructed by your caregiver: It is very important to take the proper medicine at the correct times. Ask your caregiver for a list of your medicines, and when to take them. Ask your caregiver what side effects each medicine may have and what to do if you have side effects. Also ask your caregiver before you take any new medicines or supplements.

Where can I find more information?

Contact the following:

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.americanheart.org
  

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: http://www.lungusa.org
  

When should I call my caregiver?

Call your caregiver if:

• You are gaining weight for no known reason.
  
  
• You are urinating more than normal.
  
  
• You have a fever.
  
  
• You have new or increased swelling in your legs or feet.
  
  
• You hear new or increased wheezing when you breathe.

When should I seek immediate help?

Seek immediate help or call 911 if:

• You are breathing very fast, sweating, and feel confused.
  
  
• You have chest pain or trouble breathing that is getting worse.
  
  
• Your heart is jumping or fluttering in your chest.
  
  
• You are urinating very little or not at all.
  
  
• You are coughing up pink, foamy sputum.
  
  
• Your lips and nail beds are very white or blue in color.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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