Pulmonary edema is a condition characterized by symptoms of difficulty breathing due to the accumulation of fluid in the lungs (alveoli). Pulmonary edema is divided into acute pulmonary edema, chronic pulmonary edema, and high-altitude pulmonary edema (HAPE) .
Pulmonary edema is more common in elderly people. This condition is experienced by 1 in 15 people aged 75–84 years, and 1 in 7 people aged 85 years and over with heart failure .
Causes of Pulmonary Edema
Causes of pulmonary edema are categorized into 2 groups, namely pulmonary edema associated with heart problems (cardiogenic pulmonary edema) and pulmonary edema that occurs without heart problems (noncardiogenic pulmonary edema).
Normally, the heart pumps blood around the body from a part of the heart called the left ventricle. The blood pumped from the left ventricle is blood from the lungs which contains oxygen.
Pulmonary edema caused by heart problems generally occurs because the left ventricle is unable to pump blood out of the heart maximally. As a result, blood remains in the left ventricle and causes an increase in pressure.
Increased pressure in the left ventricle will make it more difficult for blood from the lungs to enter the heart, so that the blood will pool in the pulmonary veins. If the pressure in the blood vessels of the lungs is too high, some of the fluid from the blood vessels will be pushed out and into the alveoli.
The following are some disorders of the heart that can cause pulmonary edema:
- Coronary heart disease
- Heart valve disease
Meanwhile, non-cardiogenic pulmonary edema can be caused by various conditions, including:
- Acute respiratory distress syndrome
- Viral infections, including COVID-19
- Pulmonary embolism
- Injury to the lungs
- Being at altitude (above 2,400 meters above sea level)
- Head injury or seizure
- Complications of brain surgery
- Inhaling smoke during a fire
- Exposure to toxins, such as ammonia and chlorine
- Reactions to some medications, including aspirin
Pulmonary Edema Risk Factors
Several factors that can increase a person's risk of developing pulmonary edema are:
- Have heart problems or heart failure
- Have had pulmonary edema before
- Have a lung disease, such as tuberculosis or chronic obstructive pulmonary disease (COPD)
- Have blood vessel disorders
Symptoms Edema Paru
A common symptom experienced as a result of suffering from pulmonary edema is difficulty breathing. However, other symptoms that arise can be slightly different for each person, depending on the type of pulmonary edema suffered.
In acute edema, symptoms that can occur include:
- Sudden shortness of breath, especially after exertion or when lying down
- Feeling like you are drowning or your heart is pounding
- Difficulty breathing with profuse sweating
- Making unusual breath sounds, such as rough, wheezing, or gasping breaths
- Coughing up frothy phlegm mixed with blood
- Skin that is cold and clammy or looks pale or bluish
- Fast and irregular heartbeat ( palpitations )
- Feeling dizzy, weak, or sweaty
While in chronic pulmonary edema, symptoms that may be experienced include:
- Get tired more easily
- Weight gain quickly
- Breathing becomes heavier than usual, especially with activity and lying down
- Swelling in both legs
- A lot
- Often wakes up at night due to shortness of breath
High -altitude pulmonary edema ( HAPE ) can occur when people travel or exercise at high altitudes. Signs and symptoms that may appear include:
- Shortness of breath after exertion, progressing to shortness of breath at rest
- Dry cough, which continues into a cough with frothy phlegm mixed with blood
- Difficulty walking uphill, which progresses to difficulty walking on flat surfaces
- Chest pain
- rapid heartbeat
When to see a doctor
Immediately go to the doctor or emergency room if you experience symptoms of acute pulmonary edema, HAPE pulmonary edema, or chronic pulmonary edema as mentioned above.
Don't drive yourself to the hospital. It is better to call an ambulance or medical personnel for help.
If you see someone having an attack of acute pulmonary edema, rush them to the hospital or call an ambulance. Tell the doctor the symptoms the patient is experiencing so that the doctor can provide the right help.
Routine check-ups may be recommended if you are at high risk of developing pulmonary edema, to prevent the condition from becoming severe.
Diagnosis of Pulmonary Edema
To diagnose pulmonary edema, the doctor will ask questions about the symptoms experienced and the patient's medical history, especially if the patient has had heart or lung disease.
Next, the doctor will perform a physical examination by checking the heartbeat and sounds from the lungs using a stethoscope. If needed, the doctor can also carry out a number of supporting examinations, such as:
- Pulse oximetry, to quickly measure the level of oxygen in the blood, by placing a sensor on the finger or toe
- Electrocardiogram (EKG) , to look for problems with heart rhythm, an overview of heart muscle function, and the possibility of coronary heart disease
- Chest X-ray, to confirm that the patient really has pulmonary edema, as well as to see other possible causes of shortness of breath
- Blood tests, to measure oxygen and carbon dioxide levels in the blood (blood gas analysis), measure levels of the hormone B-type natriuretic c peptide (BNP) which are elevated in heart failure , and look at thyroid and kidney function
- Echocardiography , to detect problems with the pumping function of the heart
- Cardiac catheterization , used to measure the pressure in the heart chambers, evaluate the work of the heart valves, and check the smooth flow of blood in the coronary vessels of the heart
Pulmonary Edema Treatment
As the first treatment for pulmonary edema, the patient will be given oxygen. Oxygen is given through a face mask or a small tube placed in the nose.
Based on the conditions and causes of pulmonary edema, the doctor may also prescribe one or more of the following medicines:
- Diuretics, such as furosemide , to lower pressure caused by excess fluid in the heart and lungs
- Blood pressure medication, to control high blood pressure or raise blood pressure that is too low
- Nitrate class of drugs, such as nitroglycerin , to dilate blood vessels and reduce the pressure load on the left ventricle of the heart
Most pulmonary edema conditions require treatment in the emergency room or in the intensive care unit ( ICU ). If necessary, the patient will be attached to a tube connected to a respirator to ensure that sufficient oxygen enters the body.
Complications of Pulmonary Edema
Untreated pulmonary edema can cause increased pressure in the right heart chamber, which functions to receive blood from all over the body. This condition can cause the right heart chambers to fail and cause:
- Fluid buildup in the abdominal cavity ( ascites )
- Swelling of the limbs
- Swelling of the liver
Prevention of Pulmonary Edema
The risk of developing pulmonary edema can be reduced by taking the following simple steps:
- Do regular exercise, 30 minutes every day.
- Consume healthy foods in the form of vegetables, fruits, and foods low in fat, sugar and salt. It aims to maintain body weight, blood cholesterol levels, and blood pressure within limits
- Do not smoke.
- Manage stress well.