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  Pulmonary edema

Edema is swelling and fluid accumulation in any organ or extremity of the body. Pulmonary edema is swelling and fluid accumulation in the lungs. The extra fluid and swelling drown the patient by impairing healthy gas exchange with the circulating blood and can cause respiratory failure.

Pulmonary edema
Pulmonary edema


Symptoms:

Symptoms of pulmonary edema are trouble breathing, coughing up blood, extreme sweating, apprehension and pale skin. If untreated, pulmonary edema can cause coma and even death, due to the damage caused by of hypoxia.

If pulmonary edema has been increasing slowly, symptoms of fluid excess may be detected. These include repeated urination at night (nocturia), orthopnea (inability to breathe when laying down), ankle edema (swelling of the legs and paroxysmal nocturnal dyspnea (episodes of harsh and rapid loss of breath at night).

Other general symptoms are:

 wheezing
 serious shortness of breath
 difficult breathing
 anxiety and restlessness
 cough which produces a bloody tinged sputum
 excessive sweating
 chest pain, especially when the pulmonary edema is caused by coronary artery disease

Diagnosis:

Diagnosis is determined by a medical history of cardiovascular disease and physical exam. End-inspiratory crackles heard during a stethoscope exam are the chief indicators of pulmonary edema. End-inspiratory is the end of a deep breath. A third heart sound is also a sign of pulmonary edema.

Blood tests the evaluate electrolytes, liver function, renal function; coagulation and complete blood count (CBC) are also used to determine the functioning and health of the body. B-type natriurectic peptide is a test used in many hospitals. A BNP level of less than 100 indicates that cardiac involvement is doubtful.

Confirmation of diagnosis is with an X-ray of the lungs. Increased fluid in the alveolar walls is indicative of pulmonary edema and is detectable in an X-Ray. Cardiogenic pulmonary edema is suspected when Kerley B lines, increased vascular filling, increased blood flow to the top of the lungs and pleural effusions are present on the X-ray. Patchy alveolar infiltrates within the bronchograms signal non-cardiogenic edema.

An individual who has low oxygen saturation and impaired arterial blood gas levels is also a likely patient with pulmonary edema. If the case appears urgent or life-threatening, with severe depletion of blood gas levels an echocardiograph can be used to confirm the diagnosis and rule out other possible conditions such as diseases of the heart valves.

Cause:

There are two types of pulmonary edema, non cardiogenic and cardiogenic. Pulmonary edema is caused by damage to lung tissues or poor health or functioning of the heart or cardiovascular system.

Non-cardiogenic pulmonary edema can be caused by the following

 Severe infection
 Upper airway obstruction
 Ascent to high altitude occasionally causes high altitude pulmonary edema (HAPE)
 Aspiration, e.g. gastric fluid or in case of drowning
 Multiple blood transfusions
 Inhalation of toxic gases
 Pulmonary contusion, i.e. high-energy trauma
 Multitrauma as in a severe car accident
 Neurogenic such as subarachnoid hemorrhage
 Certain types of medication
 Reexpansion: post-pneumonectomy or large volume thoracentesis
 Reperfusion injury such as postpulmonary thromboendartectomy or lung transplantation

Cardiogenic pulmonary edema can be caused by one of the following or a combination:

 Severe heart attack
 Congestive heart failure
 Pericardial effusion
 Fluid overload as in the case of kidney failure
 Tachycardia – fast heart beat
 Bradycardia – slow heart beat

Treatment:

Treatment is dependent on the cause of pulmonary edema. The initial goal is to maintain oxygenation and adequate blood gas levels. This can be achieved with high-flow oxygen, non-invasive ventilation or variable positive airway pressure or, in severe extreme cases mechanical ventilation (ventilator).

If pulmonary edema is caused by circulatory disturbances, treatment is intravenous nitrates and loop diuretics. These drugs improve preload and after load and in turn aid in cardiac function.

If direct tissue damage is causing the pulmonary edema, then either removing the damage (surgery) or curing the infection is the method of treatment.

There are no causal therapies for direct tissue damage; removal of the causes (e.g. treating an infection) is the most important measure.

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