Pulmonary edema is a specific form of edema. By edema, I mean an abnormal accumulation of water in the tissues. Thus, in pulmonary edema, increased fluid is found in the lung tissue or in the lungs directly. The cause of this condition is usually other diseases, such as cardiac insufficiency (heart failure) or various kidney diseases. Pulmonary edema should be examined and treated by a doctor as soon as possible, otherwise serious complications can occur.
What is pulmonary edema?
Pulmonary edema is characterized by a buildup of water in the lung tissue and alveoli, which can have several causes. These include heart failure and kidney disease, as well as allergies and altitude sickness. Pulmonary edema is a serious condition that requires medical treatment. Pulmonary edema can occur acutely or develop chronically, slowly and initially unnoticed. Initially, in pulmonary edema, water accumulates in the interstitial tissues of the lungs and progressively spreads to the alveoli, which are called alveoli. As a result, the lungs can no longer be adequately ventilated in pulmonary edema, impairing gas exchange and blood flow in pulmonary edema.
Causes
In most cases, the causes of pulmonary edema are heart failure or insufficiency, or kidney disease affecting kidney function, or other conditions. Therefore, a distinction is made between cardiogenic pulmonary edema and noncardiogenic pulmonary edema. When a heart can no longer function adequately, blood flows into the left ventricle without the heart being able to pump it back into the bloodstream. As a result, the pressure in the pulmonary veins rises. If the pressure is above 25 mmHG, it is a severe impairment of lung function. Water is forced out of the pulmonary capillary vessels into the surrounding tissues, causing pulmonary edema. Non-cardiogenic conditions can have allergies as a cause, and malnutrition and liver as well as kidney disease and altitude sickness are also possible causes of pulmonary edema. Generally, the causes of pulmonary edema are due to a disturbance in pressure ratios, that is, between oncotic and hydrostatic pressures within the lungs.
Symptoms, complaints, and signs
The symptoms of pulmonary edema depend on the causes that led to the edema and the stage of disease. In heart disease with fluid retention in the lungs, the main symptoms are cough and shortness of breath. A frothy or bloody sputum may also occur as an accompanying symptom of coughing. Other symptoms include accelerated breathing, shortness of breath during physical exertion or even at rest. The skin may appear pale, there may be anxiety and restlessness, the chest hurts and there may be palpitations and arrhythmias, blood pressure may be high or low. In severe cases of pulmonary edema, a distinct rattling sound can be heard. Acute pulmonary edema occurs suddenly; in addition to the other symptoms, affected individuals suffer from feelings of suffocation and sweating and should be treated immediately in the hospital. Pulmonary edema due to myocardial insufficiency usually develops rather gradually and the symptoms increase slowly. They are similar to those of acute pulmonary edema, but in addition there is fluid retention, especially in the legs, and consequent weight gain. In most cases, the affected person has difficulty breathing when lying down and wakes up during the night because of shortness of breath, which improves again when they straighten their upper body. In general, physical weakness and decreased appetite may occur.
Course of the disease
Infographic on the different lung diseases and their characteristics, anatomy, and location. Click to enlarge. In the disease process of pulmonary edema, hydrostatic pressure is the pressure of blood in the capillary vessels of the body. The protein components in the blood are responsible for the oncotic pressure. If the hydrostatic pressure in the capillary vessels increases or the oncotic pressure decreases, water leaks out of these capillary vessels into the surrounding tissue. In the lungs, it accumulates in the lung tissue or alveoli. If this process progresses, up to two liters of water can be accumulated, drastically impairing lung function and resulting in what is referred to as pulmonary edema.If pulmonary edema is present, the general condition will gradually or acutely deteriorate and breathing problems must lead to physician consultation to initiate immediate treatment. The underlying conditions for pulmonary edema rarely resolve on their own and require intensive medical care. If pulmonary edema is not treated, pneumonia can occur as a complication. In general, life is at risk for pulmonary edema, especially if heart failure is the cause.
Complications
Pulmonary edema is a very serious condition that must be treated by a physician in all cases. Without treatment, this usually results in the death of the patient. The life expectancy of the affected person is also considerably limited and reduced by the pulmonary edema. However, the further course of the disease strongly depends on the cause of this complaint. Patients primarily suffer from inner restlessness and shortness of breath. They also experience fatigue and exhaustion. Those affected can no longer perform physically heavy activities and suffer from a reduced ability to cope with stress. Furthermore, coughing and heart palpitations occur. In the worst case, the affected person loses consciousness or suffers cardiac death. Furthermore, pulmonary edema without treatment leads to pneumonia, which can also be fatal for the affected person. Treatment of this disease is causal. In many cases, surgical interventions are necessary. However, the further course of the disease and the chances of success depend greatly on the cause of this complaint. In many cases, pulmonary edema reduces the patient’s life expectancy.
When should you see a doctor?
Pulmonary edema is a life-threatening condition that requires mandatory treatment by a physician. The symptoms are usually so severe that treatment becomes essential and unavoidable. In particularly severe cases, artificial respiration is required, since breathing is very difficult with pulmonary edema. Those who leave this condition entirely without medical attention expose themselves to great danger. An accumulation of water in the lungs is life-threatening and can, under certain circumstances, also leave permanent consequential damage. For this reason, a visit to the doctor should not be put off. Only with appropriate treatment can a complete recovery be brought about. The following therefore applies: pulmonary edema is a clinical picture that absolutely requires appropriate treatment. Anyone who does not take the appropriate medication is putting his or her life in danger. In particularly acute cases, inpatient treatment may even be necessary to ensure that the patient is treated smoothly. Even with immediate medical attention, permanent damage can occur that cannot be subsequently treated or eliminated.
Treatment and therapy
Coughing, accelerated breathing, and a faster heartbeat are signs of pulmonary edema. Diagnosis requires listening to the lungs, followed by X-rays and possibly a CT scan. Blood tests and cardiac examinations as well as ultrasound examinations complete the diagnostic procedures. Intensive therapy is then initiated. Oxygen may be supplied via nasal tubes, the upper body is elevated, and medication must be taken. Depending on the cause, the body may need to be detoxified or treated for functional disorders. In the case of kidney disease, dialysis may be initiated. Pulmonary edema always requires intensive medical care.
Follow-up care
Without medical treatment, pulmonary edema leads to pneumonia, which is why regular follow-up is essential. This can also be fatal for those affected. In many cases, surgical interventions are necessary for the treatment of the disease. However, the course of the disease and the chances of successful treatment depend on the cause of its occurrence. Accordingly, general sparing and refraining from excessive physical exertion are recommended. In addition, lung patients should breathe in sea air if possible, and a visit to a salt cave can also promise relief and promote the healing process. Due to the reduced resilience, affected persons are hardly able to bear weight and are always dependent on the help and support of relatives.Everyday tasks can no longer be performed independently, which can sometimes lead to upsets. Appropriate sensitization of relatives and friends can help to better understand how to deal with the disease and improve togetherness.
Outlook and prognosis
Pulmonary edema develops because of an existing disease. Therefore, the accumulation of water in the tissues of the lungs is symptomatic and not a disease in its own right. For this reason, prognosis is based on an overall assessment of the patient’s health. Basically, it is an intensive care emergency. If the cause of the water retention is due to an allergic reaction, freedom from symptoms can often be achieved by avoiding the triggering stimulus. People suffering from altitude sickness should also avoid stays in higher altitude environments so that recovery can be permanent. A cure is not possible in either case. Freedom from symptoms is automatic if the triggers are avoided. If pulmonary edema develops due to an organic condition, the prognosis is worse overall. Functional disorders of the kidney as well as the heart are chronic or permanent in a large number of patients. Without medical care, no relief of the symptoms can be achieved in this case. Instead, an increase in health irregularities is to be expected. In the worst case, premature death of the affected person occurs. Treatment of the organ disorder is associated with various risks and side effects. Nevertheless, it currently represents the only possibility of improvement.
What you can do yourself
If pulmonary edema has been diagnosed, medical therapy is usually given directly. Medical treatment can be supported by some measures. First, it is advisable to follow the doctor’s instructions and, above all, to reliably take the prescribed medication to avoid complications. During mountain hikes, there is an increased risk of acute pulmonary edema. If symptoms such as sleep disturbances, shortness of breath, fluid retention in the limbs or headaches occur at an altitude of over 2,400 meters, descend immediately. A doctor should then be consulted. If the edema is due to heart disease, regular weighing is indicated. This will allow weight gain resulting from any edema to be detected and cleared by a physician. The physician will also recommend a low-salt diet. The affected person should also seek advice from a nutritionist and generally pay attention to a healthy lifestyle. A balanced diet, regular moderate exercise and avoidance of stress can reduce the risk of many of the causative diseases. Patients who have a history of pulmonary edema should consult a cardiologist or pulmonary specialist regularly. The primary care physician can also identify edema and initiate appropriate therapy.
