Pulmonary edema

Breathing problems require immediate diagnosis and treatment. A health care provider can base a diagnosis of pulmonary edema on the symptoms and the results of a physical exam and certain tests.

Once the condition is more stable, the provider can ask about medical history, especially a history of cardiovascular or lung disease.

Tests that can help diagnose pulmonary edema or determine the reason for fluid in the lungs include:

• Chest X-ray. A chest X-ray can confirm the diagnosis of pulmonary edema and exclude other possible causes of shortness of breath. It's usually the first test done when a health care provider suspects pulmonary edema.
• Chest computerized tomography (CT) scan. A chest computed tomography (CT) scan gives more details about the condition of the lungs. It can help a provider diagnose or rule out pulmonary edema.
• Pulse oximetry. A sensor is attached to a finger or ear. It uses light to determine how much oxygen is in the blood.
• Arterial blood gas test. This test measures the amount of oxygen and carbon dioxide in the blood.
• B-type natriuretic peptide (BNP) blood test. Increased levels of B-type natriuretic peptide (BNP) may signal a heart condition.
• Other blood tests. Blood tests to diagnose pulmonary edema and its causes also usually include a complete blood count, metabolic panel to check kidney function and thyroid function test.
• Electrocardiogram (ECG or EKG). This painless test detects and records the timing and strength of the heart's signals. It uses small sensors (electrodes) attached to the chest and sometimes to the arms or legs. Wires attach the sensors to a machine, which displays or prints results. An electrocardiogram (ECG) can show signs of heart wall thickening or previous heart attack. A portable device such as a Holter monitor may be used to continuously monitor the heartbeat at home.
• Echocardiogram. An echocardiogram uses sound waves (ultrasound) to create pictures of the beating heart. It can identify areas of poor blood flow, heart valve issues and heart muscle that is not working properly. An echocardiogram can help diagnose fluid around the heart (pericardial effusion).
• Cardiac catheterization and coronary angiogram. This test may be done if other tests don't show the cause of pulmonary edema, or when there's also chest pain. It helps health care providers see blockages in the heart arteries. A long, flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.
• Ultrasound of the lungs. This painless test uses sound waves to measure blood flow through the lungs. It can quickly reveal signs of fluid buildup and plural effusions.

The first treatment for acute pulmonary edema is oxygen. Oxygen flows through a face mask or a flexible plastic tube with two openings (nasal cannula) that deliver oxygen to each nostril. This should ease some symptoms.

A health care provider monitors the oxygen level. Sometimes it may be necessary to assist breathing with a machine such as a mechanical ventilator or one that provides positive airway pressure.

Depending on the severity of the condition and the reason for the pulmonary edema, treatment might include one or more of the following medications:

• Diuretics. Diuretics, such as furosemide (Lasix), decrease the pressure caused by excess fluid in the heart and lungs.
• Blood pressure drugs. These help manage high or low blood pressure, which can occur with pulmonary edema. A provider may also prescribe medications that lower the pressure going into or out of the heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).
• Inotropes. This type of medication is given through an IV for people in the hospital with severe heart failure. Inotropes improve heart pumping function and maintain blood pressure.
• Morphine (MS Contin, Infumorph, others). This narcotic may be taken by mouth or given through an IV to relieve shortness of breath and anxiety. But some care providers believe that the risks of morphine may outweigh the benefits. They're more likely to use other drugs.

It is important to diagnosis and treat, if possible, any nervous system problems or causes of heart failure.

Treating high-altitude pulmonary edema (HAPE)

Oxygen is the usually the first treatment. If oxygen isn't available, a portable hyperbaric chamber can imitate going down to a lower elevation until it's possible to move to a lower elevation.

Treatments for high-altitude pulmonary edema (HAPE) also include:

• Immediately going down to a lower elevation. For someone in high altitudes who has mild symptoms of high-altitude pulmonary edema (HAPE), going down 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as possible can help. Someone with severe HAPE might need rescue assistance to get off the mountain.
• Stopping exercise and staying warm. Physical activity and cold can make pulmonary edema worse.
• Medication. Some climbers take prescription medications such as acetazolamide or nifedipine (Procardia) to help treat or prevent symptoms of HAPE. To prevent HAPE, they start taking the medication at least a day before going higher.

Lifestyle changes are an important part of heart health and can help with some forms of pulmonary edema.

• Keep blood pressure under control. For high blood pressure, take medications as prescribed and check blood pressure regularly. Record the results. A health care provider can help set a target blood pressure.
• Manage other medical conditions. Address underlying medical conditions. For example, controlling glucose levels if you have diabetes.
• Avoid the cause of your condition. If pulmonary edema results from drug use or high altitudes, for example, avoiding using drugs or being in high altitudes can help prevent more lung damage.
• Don't smoke. It's always a healthy idea to stop smoking. For help with quitting, talk to a health care provider.
• Eat less salt. Salt helps the body retain fluid. In some people with damage in the left ventricle of the heart, too much salt might trigger congestive heart failure. A dietician can help with cutting salt by showing how to determine the salt content in foods and create a nutritious, good-tasting diet. In general, most people should consume less than 2,300 milligrams a day of salt (sodium). Ask your care provider what level is safe for you.
• Choose a healthy diet. A healthy diet includes plenty of fruits, vegetables and whole grains. Limit saturated fats and trans fats, added sugars, and sodium.
• Manage weight. Being even slightly overweight increases the risk of cardiovascular disease. But losing even small amounts of weight can lower blood pressure and cholesterol and reduce the risk of diabetes.
• Get regular exercise. Healthy adults should get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of the two. If you're not used to exercise, start out slowly and build up gradually. Be sure to get your care provider's OK before starting an exercise program.

If you have pulmonary edema, you will likely first be seen by an emergency room doctor. If you think you have signs or symptoms of pulmonary edema, call 911 or emergency medical help rather than making an outpatient appointment.

You may see several specialists while you're in the hospital. After you are stable, you may be referred to a doctor trained in heart conditions (cardiologist) or lung conditions (pulmonologist).

What you can do

• Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
• Write down if you have had similar symptoms in the past, even if you didn't see a health care provider.
• Write down key personal information, including any major stresses or recent life changes.
• Get copies of your medical records whenever possible. Discharge information from the hospital and results from heart tests, as well as letters from specialists you've seen can be helpful.
• Make a list of all medications as well as any vitamins or supplements you take, including doses.
• Keep written track of your weight and give that record to your care provider to look for trends.
• Make a list of the salty foods you eat regularly. Mention if you have eaten more of these recently.
• Ask a family member or friend to come along, if possible, to help you remember the information you're given.
• Write down questions to ask your care provider.

For pulmonary edema, some questions to ask include:

• What's the most likely cause of my symptoms?
• What tests do I need? Do these tests require any special preparation?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there alternatives to the treatment you're suggesting?
• What's my prognosis?
• Are there dietary or activity restrictions that I need to follow? Would it help me to see a dietitian?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you a number of questions, including:

• Have your symptoms been continuous?
• How severe are your symptoms? Have your symptoms affected your work or daily activities?
• Does anything seem to improve your symptoms?
• What, if anything, appears to make your symptoms worse?
• Have you been diagnosed with obstructive sleep apnea or do you have symptoms of obstructive sleep apnea?
• Do you have any family history of lung or heart disease?
• Have you ever been diagnosed with chronic obstructive pulmonary disease (COPD) or asthma?
• Do you smoke or did you smoke in the past? If so, how many packs a day and when did you quit?
• Do you travel to altitudes higher than 1 mile?