Richard Sheldon (Medical Advisor to the CA State Respiratory Care Board) gives expert video advice on: What are the signs and symptoms of pulmonary edema?; How can I prevent pulmonary edema? and more...
What is "pulmonary edema"?
Pulmonary edema is a term used to describe the development of lung water. This is not water that nessessarly is like a sack of water. You can develope lung water in the thoracic cavity, in the plural space and that is called a plural fusion, but that is not what we are talking about. We are talking about water that forms either in the intersticial area of the lung, or in the aveliar sack itself. It can get there because the lung is absorbing the effects of the heart failing. Then we call that congestive heart failure, it's congesting the lung with pulminary edema fluid. You can have a special system set up where the avular capilary bed gets little wholes punched in it because of infection and inflamation and then fluid, water leak into the avelas and that becomes pulminary edema. So there are many reasons for pulminary edema. But the most common reason for pulminary edema is left heart failure or for instance a heart attack, or something happens to the effieciency of the heart, so it can't pump blood forward out to the rest of the body as effciently as it once did, and so the fluid and the pressure backs up and squishes water out into the lung meat and forms pulmonary edema.
What are the signs and symptoms of pulmonary edema?
The signs and symptoms of pulmonary oedema centre around the person's breathing ability. Usually when people get pulmonary oedema they become very short of breath. It's a unique kind of shortness of breath because it usually is made better if they sit up. If a person sits up, he finds it lessens his shortness of breath; it doesn't completely resolve it, but it gets better. He can have a cough associated with that. He can have wheezing, much like an asthmatic will have. It can be accompanied by chest pain if the pulmonary oedema is caused by a heart attack. Some of the signs also include neck pains, and the jugular veins become distended because the blood is backing up. People with pulmonary oedema can become disoriented, very fatigued, easily fatigued, and frequently, if it goes on for an hour or two, they'll start to develop swelling in their ankles because the backing up of the blood not only includes the lung, but later on the liver, and down into the more dependent portions of the body where gravity pulls things down, and that would be into the ankles. So, you'll see patients with ankle oedema sometimes.
How is pulmonary edema treated?
Pulmonary oedema is treated with helping the body to resolve the underlying causes; if you can improve the efficiency of the heart. The heart is no longer going "lubb dubb" in a rhythmic way, but has now become irregular in its heartbeat. If you can correct that, you can help pulmonary oedema. If they've had a heart attack, you do whatever it takes; there are certain medications that lessen the pressures on the heart. That'll help move things forward so they can clear out the lung and get that fluid out of the lung. You'll find that oxygen is extremely important in treating these patients, but probably one of the more important drugs also is Lasix, the diuretics, to help them increase their ability to urinate out that extra fluid. There is controversy, like many things in medicine, about whether diuretics are as helpful in this situation as possible, but most of us still use diuretics in the treatment of acute pulmonary oedema. If the pulmonary oedema is not due to the left heart, but rather to a lung injury (such as with viral infections that will give you the acute respiratory distress syndrome) then these patients almost always will have to go into the intensive care unit and have a tube placed. Then pressure ventilation, with high concentrations of oxygen, is needed to treat that form of pulmonary oedema.
What is an "electrocardiogram" or "ECG"?
An electrocardiogram or ECG is a tracing made of the heart using twelve leads that will allow you to look at the heart electronically from various positions, and will help you to diagnose whether or not the heart is beating regularly or irregularly, it will also show you if there's been a heart attack and which part of the heart muscle has been damaged by a heart attack. It can tell you whether or not there is any chronic illness, especially in pulmonary medicine, we'll see what we call right ventricular hypertrophy or right axis deviation, where the heart muscle starts to swing it's main electrical events to the right side of the heart when it has always usually been to the left side where the bigger part of the muscle occurs. The electrocardiogram or ECG can demonstrate for us a lot of opportunity for improvement in the heart muscle. We can track it to see whether or not the heart muscle is getting better or worse as a result. The ECG is non-invasive, very inexpensive, and very commonly used. It can be electronically transmitted to many places throughout the United States so that if someone had a heart attack in one place, we can get that information readily in a remote place. So, using electrocardiograms or ECGs is a very important part of managing patients with lung disease and heart disease or a combination of the two.
What is "transesophageal echocardiography"?
Transoesophageal echocardiography is a highly specialised form of evaluation of the heart where you take an echo cardio transducer and you thread it down into the oesophagus, and it then allows you to study the heart and parts of the lung perfusion system. It's a very specialised test, and not frequently used. Hopefully, it will be used more and more as people become more accustomed to it. It does take some expensive equipment so it's sometimes hard to get a hospital to buy that material for you, or that instrument for you. Transoesophageal echocardiography is just a specialised way of evaluating the heart, some of the pulmonary arteries, and pulmonary veins, and how they all change due to the diseased entity that you are dealing with.
What is "cardiac catheterization"?
Cardiac catheterization is a specialized form of diagnosis where the physician will place a catheter about so long frequently through the femoral vein threaded up into the heart and pass it on into the right side of the heart and measure pressures in the right atrium, right ventricle aross the pulmonary valve and into the pulmonary artery. That takes care of the right side of the heart. The left side of the heart has to be approached through the arterial side and they will thread the catheter then up through the aorta down across the aortic valve and into the left ventricle and then measure pressures across the mitral valve, the aortic valve. They are able then also to squirt a little bit of dye into the right and left coronary arteries and see what the status of the coronary arteries are in order to determine whether or not the person needs coronary artery bypass grafting, whether they need to have a specialized form of stent put in to open up the artery so blood flow will occur because there's been some clogging of those arteries from atherosclerosis.
How does pulmonary edema affect the body?
Pulmonary oedema can have a profound effect on the body because once it forms to a degree where the patient feels short of breath, it probably is also limiting the amount of oxygen that goes to the brain, the heart, the digestive system, the kidneys, and the liver. The liver is your big detoxifying organ. Once those organs are lacking in their oxygen level, it means they can't metabolize and do their job. So, pulmonary oedema can lead to multi-organ failure. Your left ventricle stops being the effective pump that it should be. Your brain stops thinking properly. Your kidneys stop filtering properly. Your liver stops detoxifying and even making certain enzyme systems and the rest that are required for proper health. Pulmonary oedema can have a profound affect by virtue of the fact that it limits the oxygen supply to the rest of the body.
What is "hemoptysis"?
The importance of hemoptysis, which is the medical term for coughing up blood, coughing up blood should signal to a person that there is something going on that is inappropriate in their lungs. It is never proper to cough up blood, but you've got to make sure it's coming from the lung. For instance, you can have a nosebleed that will allow blood to trickle down the back of your throat and you give a cough, and for all the world you think it's coming from your lungs when it's not - it's coming from your nose. You can have bleeding in your esophagus that would come up, and then you would cough and you would think it was coming from your lungs, but even that's abnormal. Hemoptysis - coughing up blood - can signal a pulmonary embolism. It can be an early sign of a cancer of the lung. If it's blood clots and old, dry blood that's one thing. But, what you've really got to worry about is the bright, red, brisk blood that comes up. In chronic and acute bronchitis you can cough up blood that is mixed in with the mucus, little strings of it, and that's not so bad. But other forms of hemoptysis can be really a difficult issue and you need to be concerned about that and seek medical help whenever you see that.