2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation
Pulmonary Edema
Pulmonary edema causes accumulation of fluid in the lungs leading to shortness of breath and coughing of blood. Although it is commonly caused due to congestive heart failure, there might be other reasons that increase your risk of suffering from this lung condition. Our expert Dr Manisha Mendiratta,Consultant Respiratory Medicine, Saroj Super Speciality Hospital, New Delhi lends some significant inputs on this topic.
CausesPulmonary oedema is the abnormal build-up of fluid in the air sacs of the lungs because of disorders such as –
Dr Manisha explains, 'Patients suffering from heart problems or heart failure are at an increased risk of pulmonary edema. However, it does not mean that every case of pulmonary edema is due to heart problems.' Here are some of the common risk factors that make you susceptible to this lung condition -
Read about Hyperventilation — causes, symptoms, treatment and prevention. SymptomsThe common signs and symptoms of pulmonary edema which might experience, if suffering from the condition are -
DiagnosisPulmonary edema is diagnosed based on symptoms (like shortness of breath, coughing up blood and chest pain) and physical examination. Test done used to diagnosed pulmonary edema may include –
Chest X-ray: Chest X-ray is a simple, useful imaging test for diagnosing a lot of heart conditions like congestive heart failure, enlargement of the heart, heart infections and lung problems.
Blood test: It is mainly recommended to check oxygen levels in the blood and thus, determine the efficiency of lung and heart function.
ECG or echocardiography: It helps in the diagnosis of an underlying heart disease thereby aiding in the treatment option. Here are 8 tests that can tell if you have heart disease.
Pulse oximetry: A procedure used to measure blood levels of oxygen (or oxygen saturation in the blood); this test helps in the diagnosis of pulmonary oedema and also aids in the determination of the cause of the condition.
Pulmonary artery catheterization: In this procedure, a catheter is inserted into a pulmonary artery to determine the severity of heart disease or any inflammation of the organ.
Here's everything you should know about Lung Function Tests (LFTs).
TreatmentThe conventional measures used to treat pulmonary edema include –
Medications: The drugs that are normally prescribed for people suffering from this condition include diuretics (to remove excess fluid from the body). Also, medicines that improve heart functioning by controlling heartbeat, relieving pressure and strengthening heart muscle are also recommended.
Ventilation: In cases of emergency, oxygen is supplied to the heart and lungs through a face mask or with the help of a breathing tube attached to the ventilator (a breathing machine).
Other effective treatment options that are currently gaining significance include use of liposomes. According to Dr Manisha'Use of liposomal drugs or delivery of drugs through liposomes is one of the most advanced treatment option that is been used to treat pulmonary oedema in recent times. Liposomes are microscopic phospholipids bubbles with a bilayered membrane structure that are targeted to delivery drugs to the affected area'.
Read about Tara asana — a asana to strengthen your lungs.
PrognosisAlthough the prognosis of this condition is dependent on the cause, in most cases it gets better in quick time. In some case, you might need to use a breathing machine for a long time for effective results. If left untreated, pulmonary edema can be life-threatening.
PreventionPulmonary edema is not always preventable, but there are few measures that can help you to reduce the risk of suffering from this condition. Here are few tips from our expert Dr Manisha -
The content has been verified by Dr Manisha Mendiratta,Consultant Respiratory Medicine, Saroj Super Speciality Hospital, New Delhi.
More From Pulmonary EdemaHeart Failure
When people have heart failure, it means their heart does not pump as well as it should. Fluid can build up in your feet, ankles, and legs—known as edema—or fluid can build up in your lungs, known as pulmonary edema. When this happens, organs such as your kidneys, liver, and lungs do not get enough blood and oxygen, so they won't work normally.
An estimated 6.5 million Americans over the age of 20 have heart failure, and about 960,000 new cases are diagnosed every year, according to the Heart Failure Society of America. It's serious, but with expert medical care, people with heart failure can manage their symptoms and live well.
Restrictive Cardiomyopathy
A restrictive cardiomyopathy results in severe diastolic congestive heart failure with intact systolic function.
This is due to significantly impaired left ventricular relaxation, which results in increased cardiac pressure and clinical manifestations of congestive heart failure.
Etiology Causes of restrictive cardiomyopathies include:Restrictive cardiomyopathy manifests as congestive heart failure. This will result in low cardiac output symptoms and transmission of the increased left-sided cardiac pressures into the lungs causing pulmonary edema and a sense of dyspnea. With physical exertion the heart demands increased cardiac output that cannot be satisfied in states of heart failure, and thus left heart pressures increase significantly causing this transient pulmonary edema.
As those increased pressures from the left heart affect the right ventricle, right heart failure can ensue. The most common cause of right heart failure is left heart failure.Right heart failure symptoms include lower-extremity-dependant edema. When the legs are elevated at night, the fluid redistributes centrally causing pulmonary edema resulting in orthopnea (dyspnea while laying flat) or paroxysmal nocturnal dyspnea (PND). Hepatic congestion can occur causing right upper quadrant abdominal pain.
Symptoms related to low cardiac output include fatigue, weakness and, in extreme cases, cardiac cachexia can occur.
Physical Examination DiagnosisDiagnosis can be made via echocardiography and, in some cases, cardiac biopsy. Echocardiography will reveal normal left ventricular systolic function with significant diastolic impairment, frequently grade III or grade IV diastolic dysfunction (see image below).
The left and right atrium may be markedly enlarged and a pericardial effusion may be present. The myocardium itself may exhibit a "starry-sky" or a "speckled" appearance if amyloid cardiomyopathy is the etiology. Pulmonary hypertension is commonly present due to the left heart failure.
Amyloid protein deposition can be seen as apple green birefringence upon microscopic examination. Iron deposition can be detected by biopsy, as well.
TreatmentTreatment is aimed at the primary etiology, if possible; however, no specific therapy exists to improve outcomes in regard to the congestive heart failure that manifests. Diuretics are used to relieve symptoms of dyspnea from volume overload. Beta-blockers and ACE inhibitors have not been extensively studied in this setting and are not commonly used. Heart-liver transplantation is used for amyloid cardiomyopathy with a transthyretin component since this form of amyloid protein is produced in the liver.
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