Pulmonary Edema

Overview

Pulmonary edema is a buildup of fluid in the lungs, specifically in the tiny air sacs (alveoli) where oxygen normally passes into the blood. When these sacs fill with fluid, the lungs cannot transfer oxygen efficiently, and breathing becomes difficult. People may feel as if they are suffocating or drowning, especially when lying down.

The most common cause is a heart that is not pumping well, which backs up pressure into the lungs' blood vessels and pushes fluid into the air sacs. Other causes include lung injury, infections, and exposure to high altitude. Pulmonary edema that comes on suddenly and severely is a medical emergency, while slower forms still need prompt evaluation and treatment.

Common Causes

Pulmonary edema is divided into causes related to the heart and causes that are not. Common causes include:

• Heart failure: When the heart cannot pump effectively, as in heart failure, pressure builds in the lung vessels and fluid leaks into the air sacs. This is the most common cause.
• Heart attack: A heart attack can suddenly weaken the heart and trigger fluid buildup.
• Heart valve and rhythm problems: Severe valve disease or some arrhythmias can raise lung pressures.
• Lung injury or infection: Severe infection (sepsis), pneumonia, inhaled toxins, or near-drowning can damage the lungs directly.
• High altitude: Rapid ascent to high altitude can cause high-altitude pulmonary edema.

Kidney problems and severe high blood pressure can also contribute by increasing fluid in the body or in the lung vessels.

Associated Symptoms

Pulmonary edema causes breathing-related symptoms that can come on suddenly or gradually:

• Severe shortness of breath, especially when lying flat
• A feeling of suffocating or drowning, often worse at night
• Coughing, sometimes producing frothy or pink-tinged sputum
• Wheezing or gasping for air
• Rapid, shallow breathing and a rapid heartbeat
• Anxiety, restlessness, and a bluish tinge to the lips or skin in severe cases

Waking suddenly at night gasping for air, or needing to sit up or use extra pillows to breathe, are characteristic features when the heart is involved.

Diagnosis & Evaluation

Doctors diagnose pulmonary edema based on symptoms, examination of the lungs and heart, and tests. Evaluation may include:

• A chest X-ray to see fluid in the lungs
• Oxygen level measurement and blood tests, including markers of heart strain
• An electrocardiogram (ECG) to check for a heart attack or rhythm problem
• An echocardiogram to assess the heart's pumping and valves
• Additional tests to look for infection, kidney problems, or other causes

Identifying whether the cause is the heart or the lungs is important, because treatment differs.

Treatment & Management

Treatment aims to improve oxygen levels, remove excess fluid, and address the cause. In a medical setting it may include:

• Oxygen and breathing support: Supplemental oxygen, and sometimes assisted ventilation, to help breathing.
• Medications to remove fluid: Diuretics help the body clear excess fluid from the lungs.
• Treating the heart: Medicines to ease the heart's workload, control blood pressure, or open blocked arteries when a heart attack is the cause.
• Treating other causes: Antibiotics for infection, descent and oxygen for high-altitude edema, or supportive care for lung injury.

For high-altitude pulmonary edema, descending to a lower altitude promptly is a key part of treatment. Severe pulmonary edema is managed urgently in the hospital.

Reducing Your Risk

Because pulmonary edema is often linked to heart problems, managing the heart and related conditions can lower the risk:

• Care for your heart: Control blood pressure, cholesterol, and diabetes, avoid smoking, and stay active to reduce the risk of heart disease and failure.
• Manage heart failure carefully: Take medications as prescribed, limit salt and fluids as advised, and weigh yourself regularly to catch fluid buildup early.
• Watch for early warning signs: Increasing breathlessness, needing extra pillows, waking short of breath, or new leg swelling should prompt a call to your doctor.
• Treat infections promptly: Seek care for severe chest infections, which can injure the lungs.
• Ascend gradually at altitude: If traveling to high altitude, climb slowly and rest to lower the risk of high-altitude pulmonary edema.

For people with heart conditions, sticking to the treatment plan and reporting changes early can prevent a buildup of fluid from becoming severe.

When to See a Doctor

Call emergency services immediately if someone has signs of severe pulmonary edema, such as:

• Sudden, severe shortness of breath or a feeling of suffocating
• Coughing up frothy or pink-tinged sputum
• Gasping for air, blue or gray lips or skin
• Severe anxiety with chest pain or a pounding heart

See a doctor promptly for gradually worsening breathlessness, needing more pillows to sleep, waking at night short of breath, or new swelling in the legs, as these can signal a heart problem causing fluid buildup. If you develop severe breathlessness at high altitude, descend and seek help urgently.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Pulmonary edema — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Pulmonary edema.
3. National Heart, Lung, and Blood Institute (NHLBI). Heart Failure.
4. Centers for Disease Control and Prevention (CDC). Altitude Illness.