Pulmonary Edema: Short-Term Vs Chronic

Caused by excess fluid in the lungs, pulmonary edema is a condition in which fluid collects in the lung’s air sacs and makes it hard to breathe. Heart problems are usually the underlying cause, though fluid can accumulate for other reasons. Cases of both acute (sudden) and chronic pulmonary edema can occur, and treatment depends on the cause.

Types and Symptoms of Pulmonary Edema

Pulmonary edema can be caused by a variety of both heart- and non-heart-related conditions. Depending on the cause, symptoms may appear suddenly or may develop over a longer period of time. Symptoms of acute pulmonary edema include:

• •Extreme shortness of breath or difficulty breathing that gets worse when you lie down
• •A feeling as if you’re suffocating or drowning
• •Wheezing or gasping for breath
• •Anxiety, restlessness or a sense of general apprehension
• •A cough that produces frothy sputum, possibly tinged with blood
• •Chest pain (if the edema is caused by heart disease)
• •A rapid, irregular heartbeat

If you develop any of these symptoms, call 911 right away. If not treated, pulmonary edema can be fatal.

Symptoms of chronic, long-term pulmonary edema may include:

• •Being short of breath more often than usual when you’re active
• •Trouble breathing during exertion or when you’re lying flat
• •Wheezing
• •Waking up at night with a breathless feeling, one that often clears up if you sit up
• •Rapid weight gain (when edema is a result of congestive heart failure)
• •Swelling in lower extremities
• •Fatigue

In addition, pulmonary edema can develop on people who live in areas at high altitudes. Symptoms here include:

• •Shortness of breath after exertion, and eventually shortness of breath during rest
• •Cough or fever
• •Trouble walking uphill, and eventually trouble walking on flat surfaces
• •A cough with frothy sputum, possibly tinged with blood
• •A rapid, irregular heartbeat
• •Chest discomfort
• •Headaches (often the first symptom

Possible Complications

Pulmonary edema that goes untreated can increase pressure in the pulmonary artery, eventually making the heart’s right ventricle weak and causing it to start to fail. Increased pressure backs up into the right atrium of the heart and then into other areas of the body. From here, it can cause:

• •Lower extremity and abdominal swelling
• •Pleural effusion: Buildup of fluid in the membranes surrounding the lungs
• •Congestion and swelling of the liver
• •In cases of acute pulmonary edema, lack of treatment can lead be fatal. In some others, it can be fatal even with treatment

Treatment

After a diagnosis process that may involve one or more tests, oxygen is generally the first step for treating pulmonary edema. This should help ease symptoms, and your doctor will use this time to monitor your oxygen level. You may have to go on a ventilator to help with breathing.

Other medications for treatment might include:

• •Preload reducers: Medications that decrease the pressure caused by fluid entering the heart and lungs
• •Morphine: A narcotic that can be used to relieve shortness of breath and anxiety, though its risks may outweigh its benefits and many doctors will use other drugs
• •Afterload reducers: Medications that dilate the blood vessels and take some of the pressure off ventricles in the heart
• •Blood pressure medications: If you have high blood pressure when you develop edema, you’ll be given medications to control it. The same is true if you have low blood pressure.

In cases where your pulmonary edema is caused by another condition, your doctor will treat this underlying condition.

If you’re ever climbing or traveling at high altitude and experience edema-related symptoms, descending to 2,000 to 3,000 feet should reduce these symptoms, along with reducing physical activity and keeping warm. Other treatments for altitude-related pulmonary edema include:

• •Oxygen, or a portable hyperbaric chamber (imitates descent for several hours until you can actually descend)
• •Nifedipine: A medication that can reduce pressure in the pulmonary arteries
• •Rescue: If symptoms are severe, a helicopter rescue or other help with your descent might be necessary
• •Some climbers take prescriptions like acetazolamide or nifedipine to treat or prevent symptoms of pulmonary edema—this should be started at least one day before ascent

Prevention

Pulmonary edema can’t always be prevented, but preventing cardiovascular disease can help reduce your risk. Some areas include:

• •Control blood pressure
• •Watch your cholesterol
• •Don’t smoke, or quit smoking if you do
• •Eat a heart-healthy diet (low in salt, sugars and solid fats, high in fruits, vegetables and whole grains)
• •Exercise regularly
• •Maintain a healthy weight
• •Manage stress

If you travel or climb at high altitudes, acclimate slowly. Some climbers take prescription medications for prevention.

Your doctor can offer additional recommendations or treatment options for a pulmonary edema, whether short-term or chronic.

Sources:

“Pulmonary edema.” The Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/basics/definition/con-20022485

“Pulmonary edema.” MedlinePlus. https://medlineplus.gov/ency/article/000140.htm