Pulmonary edema

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Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe.

In most cases, heart problems cause pulmonary edema. But fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, trauma to the chest wall, and visiting or exercising at high elevations.

Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency requiring immediate care. Pulmonary edema can sometimes be fatal, but the outlook improves if you get treated quickly. Treatment for pulmonary edema varies depending on the cause but generally includes supplemental oxygen and medications.

Depending on the cause, pulmonary edema signs and symptoms may appear suddenly or develop over time.

HAPE can occur when people travel to or exercise at very high altitudes. Signs and symptoms are similar to those that occur with acute pulmonary edema and include:

Pulmonary edema that comes on suddenly (acute pulmonary edema) is life-threatening. Call 911 or emergency medical assistance if you have any of the following acute signs and symptoms:

Don’t attempt to drive yourself to the hospital. Instead, call 911 or emergency medical care and wait for help.

Your lungs contain numerous small, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide. Normally, the exchange of gases takes place without problems.

But in certain circumstances, the alveoli fill with fluid instead of air, preventing oxygen from being absorbed into your bloodstream. A number of things can cause fluid to accumulate in your lungs, but most have to do with your heart (cardiogenic pulmonary edema). Understanding the relationship between your heart and lungs can help explain why.

A normal heart has 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.

Your heart is composed of two upper and two lower chambers. The upper chambers (the right and left atria) receive incoming blood and pump it into the lower chambers. 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 correct direction — are gates at the chamber openings.

Normally, deoxygenated blood from all over 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.

Cardiogenic pulmonary edema is a type of pulmonary edema caused by increased pressures in the heart.

This condition usually occurs when the diseased or overworked left ventricle isn’t able to pump out enough of the blood it receives from your lungs (congestive heart failure). As a result, pressure increases inside the left atrium and then in the veins and capillaries in your lungs, causing fluid to be pushed through the capillary walls into the air sacs.

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 muscle 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.

Sometimes, a clot isn’t the cause of the problem. Instead, gradual narrowing of the coronary arteries can lead to weakness of the left ventricular muscle. Although the rest of your heart tries to compensate for this loss, there are times when it’s unable to do so effectively. The heart can also be weakened by the extra workload.

When the pumping action of your heart is weakened, blood gradually backs up into your lungs, forcing fluid in your blood to pass through the capillary walls into the air sacs. This is chronic congestive heart failure.

Heart valve problems. In mitral valve disease or aortic valve disease, the valves that regulate blood flow in the left side of your heart may not open wide enough (stenosis). Or, they don’t close completely, allowing blood to flow backward through the valve (insufficiency or regurgitation).

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 left ventricle also dilates to allow greater blood flow, but this makes the left ventricle’s pumping action less efficient.

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.

Other conditions may lead to cardiogenic pulmonary edema, such as high blood pressure due to narrowed kidney arteries (renal artery stenosis) and fluid buildup due to kidney disease or heart problems.

In normal lungs, air sacs (alveoli) take in oxygen and release carbon dioxide. In high-altitude pulmonary edema (HAPE), it’s theorized that vessels in the lungs constrict, causing increased pressure. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs.

Pulmonary edema that isn’t caused by increased pressures in your heart is called noncardiogenic pulmonary edema.

In this condition, fluid may 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. Some factors that can cause noncardiogenic pulmonary edema include:

High altitudes. Mountain climbers and people who travel to high-altitude locations run the risk of developing high-altitude pulmonary edema (HAPE).

This condition — which generally occurs at elevations above 8,000 feet (about 2,400 meters) — can also affect hikers or skiers who start exercising at higher altitudes without first becoming acclimated, which can take from a few days to a week or so. But even people who have hiked or skied at high altitudes in the past aren’t immune.

Although the exact cause isn’t completely understood, HAPE seems to develop as a result of increased pressure from constriction of the pulmonary capillaries. Without appropriate care, HAPE can be fatal, but this risk can be minimized.

If pulmonary edema continues, it can raise pressure in the pulmonary artery (pulmonary hypertension), and eventually the right ventricle in your heart becomes weak and begins to fail. The right ventricle has a much thinner wall of muscle than does the left side of your heart because it is under less pressure to pump blood into the lungs. The increased pressure backs up into the right atrium and then into various parts of your body, where it can cause:

Left untreated, acute pulmonary edema can be deadly. In some instances, it may be fatal even if you receive treatment.

Preventing conditions and situations that cause pulmonary edema can help keep pulmonary edema from developing. These measures can help reduce your risk.

Cardiovascular disease is the leading cause of pulmonary edema. You can reduce your risk of many kinds of heart problems by following these suggestions:

Watch your blood cholesterol. Cholesterol is one of several types of fats essential to good health. But too much cholesterol can be too much of a good thing. Higher than normal cholesterol levels can cause fatty deposits to form in your arteries, impeding blood flow and increasing your risk of vascular disease.

But lifestyle changes can often keep your cholesterol levels low. Lifestyle changes may include limiting fats (especially saturated fats); eating more fiber, fish, and fresh fruits and vegetables; exercising regularly; stopping smoking; and drinking in moderation.

Limit salt. It’s especially important to use less salt (sodium) if you have heart disease or high blood pressure. In some people with severely damaged left ventricular function, excess salt may be enough to trigger congestive heart failure.

If you’re having a hard time cutting back on salt, it may help to talk to a dietitian. He or she can help point out low-sodium foods as well as offer tips for making a low-salt diet interesting and good tasting.

If you travel or climb at high altitudes, acclimate yourself slowly. Although recommendations vary, most experts advise ascending no more than 1,000 to 1,200 feet (about 305 to 366 meters) a day once you reach 8,200 feet (about 2,500 meters).

Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help prevent signs and symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Continue taking the medication for about five days after you’ve arrived at your high-altitude destination.

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Pulmonary edema

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