Pulmonary edema

Diagnosis

Breathing complications demand immediate medical attention. Healthcare professionals can identify pulmonary edema through its symptoms, physical exams, and specific diagnostic tests. Once the patient’s condition is under control, the medical history is reviewed, focusing on prior cardiovascular or lung-related issues.

To diagnose pulmonary edema or ascertain the cause of lung fluid, various tests are employed:

• Chest X-ray: Primarily used when pulmonary edema is suspected, it helps confirm the diagnosis and rules out other breathing-related issues.
• Chest computerized tomography (CT) scan: Offers a detailed view of the lungs and can help confirm or eliminate the possibility of pulmonary edema.
• Pulse oximetry: A sensor, usually attached to a finger or ear, gauges the oxygen levels in the blood using light.
• Arterial blood gas test: Determines the oxygen and carbon dioxide content in the blood.
• B-type natriuretic peptide (BNP) blood test: Elevated B-type natriuretic peptide levels can indicate a heart-related problem.
• Blood tests: These typically encompass a complete blood count, metabolic panel (for kidney health), and thyroid function tests.
• Electrocardiogram (ECG or EKG): A non-invasive test that employs sensors on the chest, and occasionally the limbs, to monitor the heart’s electrical activity. It can unveil signs like heart wall thickening or past heart attacks. For extended monitoring, portable devices like the Holter monitor might be used.
• Echocardiogram: Utilizing sound waves, this test generates images of the heart in motion, identifying issues like poor blood flow, valve problems, and potential pericardial effusion.
• Cardiac catheterization and coronary angiogram: Conducted when other tests are inconclusive or alongside chest pain symptoms. It offers a view of potential blockages in the heart’s arteries. A catheter is introduced into a blood vessel, usually in the groin or wrist, and maneuvered to the heart. Dye introduced through the catheter enhances the visibility of arteries in X-ray imaging.
• Lung ultrasound: A non-invasive method using sound waves to assess lung blood flow, it can swiftly detect fluid accumulation and pleural effusions.

Treatment

Oxygen therapy is the initial treatment for acute pulmonary edema, delivered either via a face mask or a nasal cannula with dual outlets for both nostrils to alleviate symptoms. Healthcare professionals monitor oxygen levels, and if breathing becomes significantly strained, tools such as mechanical ventilators or positive airway pressure machines might be utilized.

The treatment approach for pulmonary edema can vary depending on its severity and underlying causes. Potential medications include:

• Diuretics: Medications like furosemide can reduce fluid buildup in the heart and lungs, thus decreasing the associated pressure.
• Blood pressure medications: These are employed to regulate blood pressure which can fluctuate with pulmonary edema. Drugs like nitroglycerin  and nitroprusside are examples that modulate the pressure entering or leaving the heart.
• Inotropes: Administered intravenously, these are for patients with critical heart failure in a hospital setting. They bolster the heart’s pumping capability and stabilize blood pressure.
• Morphine: Products like MS Contin and Infumorph are used to combat shortness of breath and anxiety. However, due to potential risks, some doctors prefer alternative treatments.

For High-Altitude Pulmonary Edema (HAPE):

• Oxygen: This remains the primary intervention. In situations where oxygen isn’t readily accessible, a portable hyperbaric chamber can simulate a descent to a lower altitude until actual descent is feasible.
• Descending to a lower altitude: A descent of 1,000 to 3,000 feet (approximately 300 to 1,000 meters) can be beneficial for someone at high altitudes showing mild HAPE symptoms. In severe cases, emergency evacuation might be necessary.
• Rest and warmth: It’s advisable to cease physical activity and keep warm as exertion and cold can exacerbate the condition.
• Medication: Climbers may use prescription drugs such as acetazolamide or nifedipine to treat or prevent HAPE symptoms. Typically, they begin medication a day in advance of ascending to higher altitudes.