What are the main causes of pulmonary edema. How can you recognize the symptoms of acute pulmonary edema. What treatment options are available for pulmonary edema. How does pulmonary edema affect breathing and lung function. Can pulmonary edema be prevented or managed long-term.

Understanding Pulmonary Edema: A Comprehensive Overview

Pulmonary edema is a serious medical condition characterized by an abnormal accumulation of fluid in the lungs’ air sacs (alveoli). This fluid buildup interferes with normal gas exchange, making it difficult for the lungs to oxygenate blood effectively. As a result, individuals with pulmonary edema often experience severe breathing difficulties and other associated symptoms.

The condition can be broadly categorized into two types based on its underlying cause:

• Cardiogenic pulmonary edema: Caused by heart problems
• Noncardiogenic pulmonary edema: Caused by factors unrelated to heart function

Understanding the mechanisms behind pulmonary edema is crucial for proper diagnosis and treatment. Let’s delve deeper into the causes, symptoms, and management strategies for this potentially life-threatening condition.

The Pathophysiology of Pulmonary Edema: How Does It Develop?

To comprehend pulmonary edema, it’s essential to understand how the lungs and heart work together. The lungs consist of millions of tiny air sacs called alveoli, where oxygen and carbon dioxide exchange occurs. In a healthy respiratory system, these alveoli remain filled with air. However, in pulmonary edema, they become flooded with fluid, hindering this vital gas exchange process.

How does fluid accumulate in the lungs? There are several potential mechanisms:

1. Increased hydrostatic pressure in pulmonary capillaries
2. Decreased oncotic pressure in the blood
3. Increased capillary permeability
4. Lymphatic obstruction

In cardiogenic pulmonary edema, the primary issue often stems from the left side of the heart failing to pump blood effectively. This leads to a backup of blood in the pulmonary veins, increasing pressure and forcing fluid into the alveoli. Noncardiogenic causes, on the other hand, typically involve direct damage to the lung tissue or alterations in the forces that normally keep fluid out of the alveoli.

Recognizing the Signs and Symptoms of Pulmonary Edema

The symptoms of pulmonary edema can vary depending on whether it develops acutely or chronically. Acute pulmonary edema often presents with sudden and severe symptoms, while chronic cases may have a more gradual onset.

Acute Pulmonary Edema Symptoms

• Severe shortness of breath (dyspnea)
• Feeling of suffocation or drowning
• Wheezing or gasping for air
• Coughing up pink, frothy sputum
• Rapid, irregular heartbeat
• Anxiety and restlessness
• Cold, clammy skin
• Chest pain or discomfort

Chronic Pulmonary Edema Signs and Symptoms

• Difficulty breathing during physical activity or when lying flat
• Fatigue and weakness
• Persistent cough, sometimes with blood-tinged sputum
• Swelling in the legs and feet (peripheral edema)
• Rapid weight gain due to fluid retention
• Wheezing or crackling sounds in the lungs

Is there a specific symptom that definitively indicates pulmonary edema? While no single symptom is diagnostic, the combination of severe breathlessness, coughing up pink frothy sputum, and a feeling of drowning or suffocation strongly suggests acute pulmonary edema and warrants immediate medical attention.

Causes and Risk Factors for Pulmonary Edema

Understanding the various causes of pulmonary edema is crucial for proper diagnosis and treatment. As mentioned earlier, the condition can be broadly categorized into cardiogenic and noncardiogenic types.

Cardiogenic Pulmonary Edema Causes

• Congestive heart failure
• Heart attack (myocardial infarction)
• Severe hypertension
• Valvular heart disease
• Cardiomyopathy

Noncardiogenic Pulmonary Edema Causes

• Acute respiratory distress syndrome (ARDS)
• Pneumonia
• Inhalation of toxins
• Near-drowning
• High-altitude pulmonary edema (HAPE)
• Severe infections or sepsis
• Certain medications
• Trauma to the chest wall

Are there specific risk factors that increase the likelihood of developing pulmonary edema? Yes, several factors can predispose individuals to this condition:

• Existing heart or lung conditions
• High blood pressure
• Obesity
• Smoking
• Advanced age
• Pregnancy
• High-altitude exposure

Diagnosing Pulmonary Edema: Tools and Techniques

Accurate diagnosis of pulmonary edema is crucial for effective management. Healthcare providers employ various diagnostic tools and techniques to confirm the presence of pulmonary edema and identify its underlying cause.

Physical Examination

A thorough physical examination is the first step in diagnosing pulmonary edema. The healthcare provider will listen to the patient’s lungs with a stethoscope, checking for crackling or bubbling sounds (rales) that indicate fluid in the lungs. They will also assess for signs of heart failure, such as swelling in the legs and feet, rapid heartbeat, or distended neck veins.

Diagnostic Tests

• Chest X-ray: This imaging test can reveal fluid in or around the lungs and an enlarged heart.
• Electrocardiogram (ECG): An ECG can detect heart rhythm abnormalities or signs of a heart attack.
• Echocardiogram: This ultrasound of the heart can assess its structure and function.
• Blood tests: These can check for markers of heart failure, infection, or other underlying conditions.
• Pulse oximetry: This noninvasive test measures the oxygen saturation in the blood.
• B-type natriuretic peptide (BNP) test: Elevated levels of this hormone can indicate heart failure.

How do these diagnostic tools help differentiate between cardiogenic and noncardiogenic pulmonary edema? The combination of clinical presentation, physical examination findings, and results from these tests allows healthcare providers to determine the most likely cause of pulmonary edema. For instance, an echocardiogram showing poor heart function would suggest a cardiogenic cause, while normal heart function with evidence of lung injury might point to a noncardiogenic etiology.

Treatment Approaches for Pulmonary Edema

The treatment of pulmonary edema focuses on two main goals: improving oxygenation and addressing the underlying cause. The specific treatment approach depends on the severity of symptoms and the identified cause of the edema.

Emergency Treatment for Acute Pulmonary Edema

• Oxygen therapy: Supplemental oxygen is administered to improve blood oxygen levels.
• Positioning: Patients are often placed in an upright position to ease breathing.
• Medications:
  • Diuretics to remove excess fluid
  • Morphine to reduce anxiety and ease breathing
  • Nitroglycerin to dilate blood vessels and reduce preload on the heart
  • Inotropes to improve heart function in cases of cardiogenic pulmonary edema
• Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP): These non-invasive ventilation methods can help improve oxygenation and reduce the work of breathing.
• Mechanical ventilation: In severe cases, intubation and mechanical ventilation may be necessary to support breathing.

Long-term Management

Once the acute phase is managed, treatment focuses on addressing the underlying cause:

• For cardiogenic pulmonary edema: Treatment may include medications to improve heart function, such as ACE inhibitors, beta-blockers, or digoxin.
• For noncardiogenic pulmonary edema: Treatment depends on the specific cause, such as antibiotics for pneumonia or removal from high altitude for HAPE.

What role does lifestyle modification play in the management of pulmonary edema? Lifestyle changes can be crucial in preventing recurrences, especially in cases of cardiogenic pulmonary edema. These may include:

• Maintaining a heart-healthy diet low in salt and saturated fats
• Regular exercise as recommended by a healthcare provider
• Smoking cessation
• Limiting alcohol intake
• Managing stress
• Monitoring and controlling blood pressure and blood sugar levels

Complications and Prognosis of Pulmonary Edema

Pulmonary edema can lead to several serious complications if not promptly treated. Understanding these potential outcomes is crucial for both healthcare providers and patients.

Potential Complications

• Respiratory failure: Severe pulmonary edema can progress to respiratory failure, requiring mechanical ventilation.
• Hypoxemia: Inadequate oxygenation of the blood can lead to organ dysfunction and failure.
• Pneumonia: The accumulation of fluid in the lungs can create an environment conducive to bacterial growth, increasing the risk of pneumonia.
• Pleural effusion: Fluid may accumulate in the space between the lungs and chest wall (pleural space).
• Cardiac arrhythmias: The stress on the heart can trigger irregular heart rhythms.
• Pulmonary fibrosis: In some cases, repeated episodes of pulmonary edema can lead to scarring of the lung tissue.

What factors influence the prognosis of pulmonary edema? The outlook for patients with pulmonary edema depends on several factors:

• The underlying cause
• The speed of diagnosis and treatment initiation
• The severity of the edema
• The patient’s overall health and age
• The presence of other comorbidities

Cardiogenic pulmonary edema, when related to a treatable heart condition, often has a better prognosis than some forms of noncardiogenic pulmonary edema, such as ARDS. However, with prompt and appropriate treatment, many patients can recover from pulmonary edema and return to their baseline level of functioning.

Prevention Strategies and Long-term Management of Pulmonary Edema

While not all cases of pulmonary edema are preventable, there are several strategies that can help reduce the risk of developing this condition or experiencing recurrences.

Preventive Measures

• Managing underlying health conditions: Proper control of heart disease, hypertension, and other chronic conditions can significantly reduce the risk of pulmonary edema.
• Medication adherence: Taking prescribed medications as directed is crucial, especially for those with heart conditions.
• Regular health check-ups: Routine medical evaluations can help detect and address potential risk factors early.
• Smoking cessation: Quitting smoking can improve overall lung and heart health.
• Maintaining a healthy weight: Obesity can strain the heart and increase the risk of pulmonary edema.
• Limiting salt intake: Excessive sodium can lead to fluid retention, potentially exacerbating heart failure and pulmonary edema.
• Exercise: Regular physical activity, as recommended by a healthcare provider, can improve heart and lung function.
• Altitude acclimatization: For those traveling to high altitudes, proper acclimatization can help prevent high-altitude pulmonary edema (HAPE).

How can patients effectively manage their condition long-term after experiencing pulmonary edema? Long-term management strategies often include:

• Ongoing medical care: Regular follow-ups with healthcare providers to monitor heart and lung function.
• Medication management: Adhering to prescribed medication regimens and reporting any side effects promptly.
• Self-monitoring: Learning to recognize early signs of fluid retention or worsening symptoms.
• Lifestyle modifications: Implementing and maintaining heart-healthy lifestyle changes.
• Cardiac rehabilitation: For those with heart-related pulmonary edema, participating in a structured cardiac rehab program can be beneficial.
• Stress management: Employing techniques to reduce stress, which can exacerbate heart conditions.
• Education: Staying informed about one’s condition and treatment options.

By implementing these preventive measures and long-term management strategies, individuals at risk for pulmonary edema can significantly improve their quality of life and reduce the likelihood of future episodes. However, it’s important to note that these strategies should always be tailored to individual needs and implemented under the guidance of a healthcare professional.

Pulmonary edema – Symptoms & causes

Overview

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

In most cases, heart problems cause pulmonary edema. But fluid can collect in the lungs for other reasons. These include pneumonia, contact with certain toxins, medications, trauma to the chest wall, and traveling to or exercising at high elevations.

Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency that needs immediate care. Pulmonary edema can sometimes cause death. Prompt treatment might help. Treatment for pulmonary edema depends on the cause but generally includes additional oxygen and medications.

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Symptoms

Pulmonary edema symptoms may appear suddenly or develop over time. Symptoms depend on the type of pulmonary edema.

Sudden (acute) pulmonary edema symptoms

• Difficulty breathing (dyspnea) or extreme shortness of breath that worsens with activity or when lying down
• A feeling of suffocating or drowning that worsens when lying down
• A cough that produces frothy sputum that may have blood in it
• A rapid, irregular heartbeat (palpitations)
• Anxiety, restlessness or a feeling that something bad is about to happen
• Cold, clammy skin
• Wheezing or gasping for breath

Long-term (chronic) pulmonary edema signs and symptoms

• Awakening at night with a cough or breathless feeling that may be relieved by sitting up
• Difficulty breathing with activity or when lying flat
• Fatigue
• More shortness of breath than usual when you’re physically active
• New or worsening cough
• Rapid weight gain
• Swelling in the legs and feet
• Wheezing

High-altitude pulmonary edema (HAPE) signs and symptoms

high-altitude pulmonary edema (HAPE) can occur in adults and children who travel to or exercise at high altitudes. Symptoms are similar to those that occur with acute pulmonary edema and can include:

• Headache, which may be the first symptom
• Shortness of breath with activity, which becomes shortness of breath at rest
• Not being able to exercise as much as you once could
• Dry cough, at first
• Later, a cough that produces frothy sputum that may look pink or have blood in it
• A very fast heartbeat (tachycardia)
• Weakness
• Chest pain
• Low fever

Symptoms of high-altitude pulmonary edema (HAPE) tend to get worse at night.

When to see a doctor

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

• Shortness of breath, especially if it comes on suddenly
• Trouble breathing or a feeling of suffocating (dyspnea)
• A bubbly, wheezing or gasping sound when breathing
• Coughing up phlegm that looks pink or has blood in it
• Breathing difficulty with a lot of sweating
• A blue or gray color to the skin
• Confusion
• A big drop in blood pressure that causes lightheadedness, dizziness, weakness or sweating
• A sudden worsening of any of pulmonary edema symptoms

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

Causes

The causes of pulmonary edema vary. Pulmonary edema falls into two categories, depending on where the problem starts.

• If a heart problem causes the pulmonary edema, it’s called cardiogenic pulmonary edema. Most often, the fluid buildup in the lungs is due to a heart condition.
• If pulmonary edema is not heart related, it’s called noncardiogenic pulmonary edema.
• Sometimes, pulmonary edema can be caused by both a heart problem and a nonheart problem.

Understanding the relationship between the lungs and the heart can help explain why pulmonary edema may occur.

How the lungs work

Lungs contain many small, elastic air sacs called alveoli. With each breath, these air sacs take in oxygen and release carbon dioxide. Typically, this exchange of gases occurs without problems.

But sometimes, the alveoli fill with fluid instead of air. This keeps the bloodstream from taking in oxygen.

How the heart works

The typical heart is made 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 (right and left ventricles). The lower chambers pump blood out of the heart.

Typically, blood without oxygen from all over the body enters the right atrium then the right ventricle. From there it’s pumped through large blood vessels (pulmonary arteries) to the lungs. There, the blood releases carbon dioxide and picks up oxygen as it flows by the alveoli.

The oxygen-rich blood then returns to the left atrium through the pulmonary veins. It then flows through the mitral valve into the left ventricle. Finally, it leaves the heart through the body’s main artery (aorta).

The heart valves keep blood flowing in the right direction. The aortic valve keeps the blood from flowing backward into the heart. From the aorta, the blood travels to the rest of the body.

Chambers and valves of the heart

A typical 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 the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Heart-related (cardiogenic) pulmonary edema

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

It’s usually a result of heart failure. When a diseased or overworked left lower heart chamber (left ventricle) can’t pump out enough of the blood it gets from the lungs, pressures in the heart go up. The increased pressure pushes fluid through the blood vessel walls into the air sacs.

Medical conditions that can cause heart failure and lead to pulmonary edema include:

• Coronary artery disease. Over time, the arteries that supply blood to the heart muscle can become narrow from fatty deposits (plaques). A slow narrowing of the coronary arteries can weaken the left ventricle.

  Sometimes, a blood clot forms in one of these narrowed arteries. The clot blocks blood flow and damages part of the heart muscle, resulting in a heart attack. A damaged heart muscle can no longer pump as well as it should.

• Cardiomyopathy. This term means heart muscle damage. With cardiomyopathy, the heart must pump harder, and pressures rise. Then the heart might not be able to work harder when needed, such as during exercise or with an infection or a rise in blood pressure. When the left ventricle can’t keep up with the demands that are placed on it, fluid backs up into the lungs.
• Heart valve problems. Narrowing (stenosis) of the aortic or mitral heart valves or a valve that leaks or doesn’t close properly affects blood flow into the heart. A valve leak that develops suddenly might cause sudden and severe pulmonary edema.
• High blood pressure (hypertension). Untreated or uncontrolled high blood pressure can enlarge the heart.
• Other heart problems. Inflammation of the heart muscle (myocarditis), heart problems present at birth (congenital heart defects) and irregular heart rhythms (arrhythmias) also may cause pulmonary edema.
• Kidney disease. High blood pressure due to narrowed kidney arteries (renal artery stenosis) or fluid buildup due to kidney disease can cause pulmonary edema.
• Chronic health conditions. Thyroid disease and a buildup of iron (hemochromatosis) or protein (amyloidosis) also may contribute to heart failure and cause pulmonary edema.

Non-heart-related (noncardiogenic) pulmonary edema

Pulmonary edema that is not caused by increased pressures in the heart is called noncardiogenic pulmonary edema.

Causes of noncardiogenic pulmonary edema include:

• Acute respiratory distress syndrome (ARDS). This serious disorder occurs when the lungs suddenly fill with fluid. Many conditions can cause acute respiratory distress syndrome (ARDS), including severe injury (trauma), widespread infection (sepsis), pneumonia and severe bleeding.
• Drug reaction or drug overdose. Many drugs — ranging from aspirin to illegal drugs such as heroin and cocaine — are known to cause pulmonary edema.
• Blood clot in the lungs (pulmonary embolism). A blood clot moving from the blood vessels in the legs to the lungs can cause pulmonary edema.
• Exposure to certain toxins. Inhaling toxins or breathing in some stomach contents when vomiting (aspiration) causes intense irritation of the small airways and air sacs, resulting in fluid buildup.
• High altitudes. Pulmonary edema has been seen in mountain climbers, skiers, hikers and other people who travel to high elevations, usually above 8,000 feet (about 2,400 meters). High-altitude pulmonary edema (HAPE) generally occurs in those who don’t take the days or weeks needed to become used to the elevation. But people who live at high altitudes can get HAPE with no elevation change if they have a respiratory illness.
• Near drowning. Inhaling water causes fluid buildup in the lungs.
• Negative pressure pulmonary edema. A blocked upper airway causes negative pressure in the lungs from trying to breathe through the blockage. With treatment, most people with this type of pulmonary edema recover in about 24 hours.
• Nervous system conditions or surgeries. A type of pulmonary edema called neurogenic pulmonary edema can occur after a head injury, seizure or brain surgery.
• Smoke inhalation. Smoke from a fire contains chemicals that damage the membrane between the air sacs and the capillaries. The damage allows fluid to enter the lungs.
• Transfusion-related lung injury. Blood transfusions may cause fluid overload in the left ventricle, leading to pulmonary edema.
• Viral illnesses. Viruses such as the hantavirus and dengue virus can cause pulmonary edema.

High-altitude pulmonary edema

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

Risk factors

Heart failure and other heart conditions that raise pressure in the heart increase the risk of pulmonary edema. Risk factors for heart failure include:

• Irregular heart rhythms (arrhythmias)
• Alcohol use
• Congenital heart disease
• Coronary artery disease
• Diabetes
• Heart valve disease
• High blood pressure
• Sleep apnea

Some nervous system conditions and lung damage due to near drowning, drug use, inhaling smoke, viral illnesses and blood clots also raise the risk.

People who travel to high-altitude locations above 8,000 feet (about 2,400 meters) are more likely to develop high-altitude pulmonary edema (HAPE). It usually affects those who don’t take the time — a few days to a week or more — to get used to the elevation.

Children who already have pulmonary hypertension and structural heart defects may be more likely to get HAPE.

Complications

Complications of pulmonary edema depend on the cause.

In general, if pulmonary edema continues, the pressure in the pulmonary artery can rise (pulmonary hypertension). Eventually, the heart becomes weak and begins to fail, and pressures in the heart and lungs go up.

Pulmonary edema complications may include:

• Breathing difficulty
• Swelling of the legs, feet and belly area
• Buildup of fluid in the membranes that surround the lungs (pleural effusion)
• Congestion and swelling of the liver

Immediate treatment is necessary for acute pulmonary edema to prevent death.

Prevention

You may be able to prevent pulmonary edema by managing existing heart or lung conditions and following a healthy lifestyle.

For example, controlling cholesterol and blood pressure can help lower the risk of heart disease. Follow these tips to keep your heart healthy:

• Eat a healthy diet rich in fresh fruits, vegetables, whole grains, fat-free or low-fat dairy, and a variety of proteins.
• Don’t smoke.
• Get regular exercise.
• Limit salt and alcohol.
• Manage stress.
• Manage weight.

Preventing high-altitude pulmonary edema (HAPE)

To prevent HAPE, gradually ascend to high elevations. Although recommendations vary, most experts advise increasing elevation no more than 1,000 to 1,200 feet (about 300 to 360 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 symptoms of HAPE. To prevent HAPE, start taking the medication at least one day before ascent. Ask your health care provider how long you need to take the medication after you’ve arrived at your high-altitude destination.

Types, Causes, Symptoms, Treatment, and Diagnosis

Written by WebMD Editorial Contributors

• What Is Pulmonary Edema?
• Pulmonary Edema Symptoms
• Pulmonary Edema Causes
• Pulmonary Edema vs. Pleural Effusion vs. Pneumonia
• Pulmonary Edema Diagnosis
• Pulmonary Edema Treatment
• Pulmonary Edema Prevention
• More

Pulmonary edema is a buildup of fluid in your lungs. That can make it hard for you to breathe.

When you take a breath, your lungs should fill with air. If you have pulmonary edema, they fill with fluid instead. When that happens, oxygen from the air can’t get from your lungs into your blood, where it’s needed.

Acute pulmonary edema comes on suddenly and can be life-threatening. If you have any of these symptoms, call 911 right away:

• Sudden shortness of breath, especially after activity or while lying down
• Feeling like you’re drowning or your heart is dropping
• Anxiety
• Trouble breathing with a lot of sweating
• Breathing that sounds bubbly, wheezing, or gasping
• Coughing up pink, frothy spit
• Skin that’s cold and clammy or looks blue or gray
• A rapid, uneven heartbeat (palpitations)
• Feeling lightheaded, dizzy, weak, or sweaty, which can signal a drop in blood pressure

When the problem happens over time, it’s called chronic pulmonary edema. You may:

• Be tired
• Gain weight rapidly (this may be a sign of fluid buildup and congestive heart failure)
• Have more breathing problems than usual when you’re active
• Have swollen legs and feet
• Have trouble breathing when lying down
• Wake up at night with a breathless feeling that gets better if you sit up
• Wheeze

There are two main kinds of pulmonary edema: cardiogenic and noncardiogenic.

Cardiogenic pulmonary edema

This type is caused by a problem with your heart.

In many cases, your left ventricle (one of the chambers of your heart) isn’t able to pump out blood that enters through blood vessels from your lung. This creates a buildup of pressure and fluid.

Narrow arteries, heart muscle damage, heart valve problems, and high blood pressure are among the conditions that can weaken your left ventricle.

Noncardiogenic pulmonary edema

This type isn’t related to heart problems. Other causes include:

• Acute respiratory distress syndrome (ARDS)
• Blood clots
• Brain surgery or conditions such as seizures and head injuries
• High pressure in your chest after your airway is blocked
• Contact with ammonia, chlorine, or other toxins
• Inhaling smoke that has certain chemicals
• Lung injury after removal of blood clots
• Near-drowning 
• Reaction to some drugs, including aspirin
• Opioid overdose
• Blood transfusion
• Viral infections
• Pneumonia
• Blood poisoning or sepsis

Pulmonary edema also can be brought on from being in high altitudes, usually above 8,000 feet. Mountain climbers should get to lower ground and seek medical attention if they have:

• Chest discomfort
• Cough
• Cough with frothy spit that may have some blood in it
• Fast, irregular heartbeat
• Fever
• Headache
• Shortness of breath when they’re active that gets worse over time
• Trouble walking uphill that leads to trouble walking on a flat surface

It’s easy to get pulmonary edema mixed up with some other lung conditions.

Pleural effusion

Unlike pulmonary edema, in which fluid collects inside your lungs, pleural effusion is when it builds up in the layers of tissue that line the outside of your lungs and the inside of your chest. Symptoms include chest pain, shortness of breath, and a dry cough. It can be caused by problems like heart failure, blood clots, pneumonia, kidney disease, and tuberculosis.

Pneumonia

Pneumonia also leads to fluid buildup in the tiny air sacs in your lungs, but it’s caused by an infection with a virus, bacteria, or fungus. Symptoms include chest pain, coughing, fatigue, a fever, shortness of breath, and stomach problems. Pneumonia can sometimes cause pulmonary edema.

To help your doctor find out what’s going on, you may need to:

• Answer questions about your medical history
• Have a physical exam
• Get a chest X-ray so the doctor can study your heart and lungs
• Have heart tests to measure how well your heart beats
• Have a blood test to find out how much oxygen and carbon dioxide are in your blood

If you’re having trouble breathing and your oxygen level is low, you’ll get oxygen right away. You may get it through a face mask, or with tubes put inside your nostrils.

Your treatment will depend on what’s causing your pulmonary edema. Whether it’s your heart, medication, or an illness, your doctor will try to deal with the problem that brought it on.

The doctor may prescribe medicine such as a diuretic to lower the pressure on your heart and lungs.

Some lifestyle changes can prevent pulmonary edema or help keep the condition in check. Keep your heart healthy by:

• Eating plenty of vegetables, fruits, and whole grains
• Eating less salt
• Getting regular exercise
• Quitting smoking 
• Keeping a healthy weight 

If you’re going somewhere at a higher elevation, try to get used to the altitude change slowly. Talk to your doctor about medications that might make you less likely to get high-altitude pulmonary edema.

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Swelling of the legs: reasons for which doctor to contact

Why do edemas appear on the legs? The doctors of the Expert Clinic Smolensk talk about the reasons for their occurrence and what to do if they appear.

Why do leg swellings appear? The doctors of the Expert Clinic Smolensk talk about the reasons for their occurrence and what to do if they appear.

Ladenkova Natalya Viktorovna, therapist

– Natalya Viktorovna, what diseases cause swollen legs?

– It can be heart failure in case of heart diseases, diseases of the lymphatic system, varicose veins of the lower extremities, kidney disease (in this case, swelling may appear on the face and both extremities), decompensation in diseases of the hepatobiliary system, various oncological pathologies. We encounter edema in the legs with alimentary insufficiency, in particular, with poor protein nutrition, anemia, when general swelling appears.

The cause of edema, including in the legs, can be endocrine pathology: overweight, changes in hormonal levels in women, diseases of the thyroid gland, adrenal glands. In addition, sometimes the cause of swelling of the legs may be the lifestyle of patients, and not any pathology. For example, with excessive consumption of a large amount of liquid (tea, coffee, other drinks), salt; prolonged sitting on soft and low chairs, in armchairs; certain sports – too intense and uncontrolled running, walking, strength and static exercises.

– Which doctor should I contact with leg swelling? Which one to start with?

– From a general practitioner or general practitioner. The doctor will conduct an examination, collect an anamnesis, draw up a plan of diagnostic measures – what exactly needs to be examined and, as they say, in which direction to move. Depending on the diagnosis, the therapist himself can deal with the treatment, or, if necessary, he will refer the patient to a narrow specialist – for example, a gynecologist, cardiologist, vascular surgeon, endocrinologist, oncologist, nephrologist.

You can make an appointment with specialists here

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– There are two large groups of reasons why the legs swell : physiological and pathological. The first includes a violation of the fluid intake and excessive salt intake, excessive physical activity – for example, walking, running. Also on this list: gaining excess weight quickly, wearing “wrong” shoes or tight clothing, maintaining an uncomfortable posture for a long time.

Now pathological causes. Among cardiac pathologies, this is, first of all, heart failure.

– Can pain in the heart and swelling of the legs be related?

– Yes, there is such a connection. When the heart muscle – the myocardium – begins to suffer from a lack of oxygen, such pain may indicate the appearance of angina pectoris. They arise, as a rule, paroxysmal, localized behind the sternum, can spread to the left shoulder, neck. Pain in the region of the heart often precedes the appearance of swelling of the legs, or appear along with them. That is, one should focus more on coronary heart disease, and edema is already considered as a complication, as one of the symptoms of this disease.

You can read more about coronary heart disease in our article

The heart loses the ability to pump the entire volume of incoming blood: first, it begins to accumulate in large vessels going to the heart, then the left parts of the heart fail, and the right parts gradually join. As a result, the pressure in the inferior and superior vena cava increases. In general, this is called stagnation in the systemic circulation. Under the influence of gravity, blood accumulates in the lower extremities, and we observe cardiac edema of the legs.

Cardiac output also decreases, which contributes to the stagnation of venous blood. The filtration rate in the kidneys decreases due to vasoconstriction, including the vessels of the kidneys, urine becomes smaller, and more fluid accumulates in the body.

Lead to heart failure: coronary heart disease, arterial hypertension, various types of cardiomyopathy, rheumatic heart disease, congenital malformations, arrhythmia, pericarditis, the so-called “cor pulmonale” – when pulmonary embolism occurs, or this type of pathology can lead to prolonged chronic lung diseases due to increased pressure in their vessels.

– Irina Anatolyevna, is there a possible connection between swelling of the legs and shortness of breath?

– Shortness of breath is one of the leading symptoms of heart failure. The pumping function of the heart is disturbed not only in the large, but also in the small circle, the pulmonary vessels overflow with fluid, gas exchange and, accordingly, breathing are disturbed. And with heart failure, as I said, swelling of the legs appears. With their appearance, shortness of breath increases, a person does not have enough air even with minor physical exertion.

Minchenkova Ekaterina Alexandrovna, obstetrician-gynecologist

– Many people ask: “Why do legs swell during pregnancy”? The first reason is the insufficient daily amount of water consumed. Someone thinks that tea, coffee, juices that they drink are enough. No, this is not taken into account, you need to drink one and a half to two liters of pure water a day. In the event of its deficiency, the body begins to store water, which means that the expectant mother gets what everyone wants to avoid: swelling begins. In addition, do not forget about the risk of dehydration, especially in cases where the pregnancy proceeds in the heat.

Now about nutrition. Excessive consumption of salty foods, all kinds of chips, quickly digestible carbohydrates leads to the appearance of edema.

The third reason: the pathology of the kidneys – when they can not cope with the removal of fluid from the body.

There is also such a pathology, it is sometimes called the “disease of pregnant women” – preeclampsia. It is accompanied by an increase in blood pressure, the appearance of protein in the urine, and, among other things, swelling of the legs.

During the normal course of pregnancy in women, hormonal levels naturally change. At the same time, the content of the hormone progesterone significantly increases in the body of the expectant mother. This hormone can cause fluid retention and accumulation, which also contributes to the appearance of edema.

And one more reason. By the end of gestation, the uterus is already noticeably enlarged, it squeezes the vessels somewhat, and the outflow of venous blood and lymph from the lower extremities worsens – this can also lead to edema.

– Ekaterina Alexandrovna, is it possible to avoid the appearance of leg edema during pregnancy?

– In recent years, after numerous studies, it has been proven that 80% of pregnant women have physiological edema, which cannot be prevented in any way, but this allows them to safely carry on and give birth to healthy babies. It happens that a woman does without edema, but in most cases they are still present. And recommendations such as proper nutrition, drinking enough water and moderate exercise can be considered as prevention of edema.

“Despite the fact that pregnancy is a physiological condition, and in the time of our grandmothers, a woman did not go to the doctor as often as she does now, the diseases associated with it occurred in the past. ” Quote from the material “How to prepare for pregnancy”

Asnin Efim Semenovich, vascular surgeon

– Slight swelling is not always a sign of some kind of disease. Edema may appear, for example, if you spend a lot of time sitting at a table without moving. Or at work you have to stand a lot. In such cases, the edema is mild, usually in the lower legs, and disappears fairly quickly after a short warm-up or rest with legs raised up.

When these symptoms are pronounced and do not disappear for a long time, they are most likely associated with some kind of disease. There are edemas:

– cardiac;

– renal;

– pulmonary;

– associated with venous insufficiency;

– associated with hormonal disorders;

– the so-called protein-free – with general exhaustion and a decrease in the content of protein in the blood;

– associated with taking medications (including steroid hormones, some cardiac drugs), hormonal contraceptives.

Would you like to learn more about hormonal contraceptives? Read our article

– Efim Semenovich, and from the standpoint of a vascular surgeon, what can you say about swelling of the legs?

– The most common cause is varicose veins of the lower extremities, commonly known as varicose veins. In women, it occurs more often than in men, due to physiological characteristics. Blood flow in a person is carried out as follows: blood comes from the legs, enters the abdominal cavity, then into the chest and then to the heart. For example, during pregnancy, the growing uterus compresses the venous vessels. Blood stagnates in the abdominal cavity, the veins of the legs dilate, and the venous valves that keep the return flow of blood do not work fully. As a result, blood begins to accumulate in the vessels of the lower extremities.

In men, varicose veins are most often associated with flat feet. Normally, the human foot has two arches – longitudinal and transverse, they, together with the lower leg, create the effect of depreciation when walking. All this in the complex is called a muscle pump, which helps to drive blood away from the foot back to the heart. With the appearance of flat feet, this factor stops working, the superficial veins on the leg expand. Ultimately, if varicose veins are not treated, very serious consequences can occur, up to the appearance of varicose-trophic ulcers, which are extremely difficult to treat.

To avoid consequences, people with flat feet need to wear special orthopedic insoles that help to turn on the very muscle pump.

More information about flat feet in adults can be found here

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The Ministry of Health told about heart complications after COVID-19

Those who have recovered from COVID-19 may experience shortness of breath, asthma attacks, swelling of the lower extremities, or “interruptions” in the work of the heart – markers of problems with the cardiovascular system, said Evgeny Shlyakhto, President of the Russian Society of Cardiology. According to him, with such symptoms, it is necessary to see a doctor as soon as possible.

Coronavirus infection is often accompanied by complications of the cardiovascular system. This was warned by the Director General of the NMIC them. V. A. Almazov of the Ministry of Health of the Russian Federation, President of the Russian Society of Cardiology Evgeny Shlyakhto.

According to him, those who have been ill with coronavirus should see a doctor as soon as possible if they have shortness of breath, asthma attacks, swelling of the lower extremities, or “interruptions” in the work of the heart.

“Patients with cardiovascular diseases are a particularly vulnerable group in the situation of the spread of a new coronavirus infection, as they have a high risk of severe course and adverse outcomes of COVID-19,” the website of the Ministry of Health says.

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With a new type of coronavirus infection, blood clots form in patients, due to which doctors are forced to perform amputations of limbs, Novaya Gazeta previously cited Viktor Anosov, a doctor at the Filatov City Clinical Hospital No. 15 in Moscow.

“A blood clot in the head – a stroke, in the heart – a heart attack, in the lungs – a pulmonary embolism. It’s easier with limbs. Amputations take place every day, ”said the specialist.

He noted that blood clots form in all patients with COVID-19, since this is a common complication with a new type of coronavirus.

The D-dimer indicator, which shows the tendency of the body to form blood clots, should normally be 1-2 nanograms per milliliter of blood, a maximum of 500, while in patients with coronavirus, as the doctor indicated, this figure reaches 1-7 thousand.

In addition , every fifth person who recovers from coronavirus has mental disorders, including those diagnosed for the first time after infection, scientists from Oxford University found. The study was published in The Lancet Psychiatry.

“From the early days of the COVID-19 pandemic, concerns have been raised about its impact on mental health and on patients with mental illness,” the authors write. “However, months later, we still know little about the mental health consequences and vulnerability of patients with mental illness.”

Psychiatric symptoms complicate medical care and contribute to increased morbidity and mortality, the researchers note.

In addition, individuals with severe mental illness are known to have a high prevalence of comorbidities and bad habits associated with COVID-19 symptomsincluding obesity, hypertension, smoking and type 2 diabetes.

Many people with mental disorders also live in poor social conditions, where they are often exposed to respiratory viruses.

“People were worried that COVID-19 victims would be at risk for mental health problems,” said psychiatry professor Paul Harrison, one of the study’s authors. “And our results show that it is quite likely.”

To understand the relationship between COVID-19and mental illness, the researchers analyzed more than 70 million electronic health records in the United States, including more than 62,000 cases of coronavirus that did not require emergency care or hospitalization.

Patients who have recovered from COVID-19 coronavirus often experience serious health problems even after a complete recovery from the infection, Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, confirmed at a briefing in Geneva.

According to him, painful symptoms can even intensify over time and at the same time manifest themselves in any vital body systems.

The specialist pointed out that even people who have overcome COVID-19 experience increased fatigue, cough, difficulty breathing, inflammation and damage to the lungs and heart for a long time.

Recovery from a new type of coronavirus can sometimes take several months, Ghebreyesus detailed, explaining that WHO will look for treatments for COVID-19to avoid serious consequences.

Another consequence of the coronavirus can be hair loss. As trichologist Natalya Yakovleva said, in such cases, you should not self-medicate, but it is better to consult a specialist, writes News.