Pulmonary edema overview: Difference between revisions
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pulmonary edema is fluid accumulation in the lungs. This fluid accumulation leads to impaired gas exchange and hypoxia.
Historical Perspective
Pulmonary edema was first described as a result of heart failure by Andreas Nerlich. In 1891 the first case of high altitude pulmonary edema was reported. In 1908, W. T. Shanahan noted acute pulmonary edema as an adverse effect of epileptic seizures.
Classification
Pulmonary edema can be classified on the basis of etiology into 2 subtypes, including cardiogenic pulmonary edema (left ventricular failure, myocardial infarction, left ventricle hypertrophy cardiomyopathy) and, noncardiogenic pulmonary edema (acute respiratory distress syndrome, pneumonia, pulmonary embolism, chest trauma).
Pathophysiology
Pulmonary edema is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema"), or due to a direct injury to the lung parenchyma or increased permeability or leakiness of the capillaries ("noncardiogenic pulmonary edema").
Causes
Common causes of cardiogenic pulmonary edema are cardiomyopathy, congestive heart failure, coronary heart disease, aortic regurgitation, aortic stenosis. Common causes of noncardiogenic pulmonary edema are acute respiratory distress syndrome, high altitude pulmonary edema, pulmonary embolism.
Differentiating Pulmonary edema from Other Diseases
Epidemiology and Demographics
The prevalence of pulmonary edema was estimated to be 75000-83000 cases per 100,000 individuals among heart failure patients with reduced ejection fraction. Pulmonary edema commonly affects individuals older than 65 years of age. Males are more commonly affected by pulmonary edema than woman.
Risk Factors
The risk factors in pulmonary edema refer to the risk factors for the underlying disease that cause pulmonary edema. Risk factors of cardinogenic pulmonary edema include high blood pressure, hyperlipidemia, atherosclerosis, diabetes mellitus, obesity. And risk factors for noncardiogenic pulmonary edema include sepsis, aspiration, pneumonia.
Screening
Natural History, Complications and Prognosis
Some patients may need to use a breathing machine for a long time, which may lead to damage to lung tissue.Kidney failure and damage to other major organs may occur if blood and oxygen flow are not restored promptly. If not treated, this condition can be fatal. If left untreated, acute pulmonary edema can lead to coma and even death, generally due to its main complication of hypoxia.
Diagnosis
History and Symptoms
The history of a patient with pulmonary edema varies according to the underlying cause. The most common symptom of pulmonary edema is shortness of breath(dyspnea). Depending on the cause it it may occur acutely or has gradual onset. When pulmonary edema is due to an acute myocardial infarction chest pain is common symptom.
Physical Examination
Patients with pulmonary edema usually appear agitated. Physical examination of patients with pulmonary edema is usually remarkable for dyspnea, tachypnea. The presence of abnormal cardiac examination on physical examination is diagnostic of cardiogenic pulmonary edema. Patients with noncardiogenic pulmonary edema may have warm extremities, whereas patients with cardiogenic pulmonary edema may have cool extremities.
Laboratory Findings
Chest X Ray
The diagnosis is confirmed on X-ray of the lungs, which shows increased fluid in the alveolar walls. Kerley B lines, increased vascular filling, pleural effusions, upper lobe diversion (increased blood flow to the higher parts of the lung) may be indicative of cardiogenic pulmonary edema, while patchy alveolar infiltrates with air bronchograms are more indicative of noncardiogenic edema
CT
Echocardiography
Echocardiography is useful in confirming a cardiac or no-cardiac cause of pulmonary edema. Echocardiography may identify the presence and severity of valvular causes of pulmonary edema. Echocardiography is helpful in diagnosis of ischemia or myocardial infarction, cardiomyopathy as an underlying cause of pulmonary edema. Echocardiography is less sensitive in identifying diastolic dysfunction. Thus, a normal echocardiogram may not rule out cardiogenic pulmonary edema.
Other imaging findings
There are no additional imaging findings associated with pulmonary edema.
Other diagnostic findings
Pulmonary artery catheterization is the gold standard test for the diagnosis of pulmonary edema. Elevated pulmonary-artery pressure indicates cardiogenic pulmonary edema or pulmonary edema due to volume overload.
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References