Hypoxia-induced signaling in the cardiovascular system: pathogenesis and therapeutic targets



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Things You Need To Know About Pulmonary Edema

What is Pulmonary Edema?

Pulmonary edema is a condition where fluid accumulates in the lungs.

The lungs are organs of respiration. Oxygen from the air passes through small air sacs of the lungs called alveoli and oxygenates the blood in small blood vessels surrounding the alveoli called pulmonary capillaries. Carbon dioxide from the blood diffuses into the alveoli and is removed from the body when the person breathes out.

The alveoli and the pulmonary capillaries are separated by lung tissue called the interstitium. Any fluid from the pulmonary capillaries that seeps into the interstitium is removed by the lymphatic system. This prevents accumulation of fluid in the lung tissue.

If large amounts of fluid seep into the interstitial space, the lymphatics may be unable to remove it, especially if it accumulates suddenly. This results in pulmonary edema. As the condition worsens, the fluid fills the alveoli as well, making the exchange of oxygen and carbon dioxide difficult.

The main factors which can result in pulmonary edema:

  • Increased pressure in the pulmonary capillaries, which pushes the fluid into the interstitial space
  • Damage to the pulmonary capillaries, which increases capillary permeability and results in seepage of fluid through its walls into the interstitial space

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    Cardiogenic and Non-cardiogenic Pulmonary Edema

    Pulmonary edema is of two main types depending on the cause. When it occurs due to a problem with the functioning of the left side of the heart, it is referred to as cardiogenic pulmonary edema. If it occurs due to any other cause, it is referred to as non-cardiogenic pulmonary edema. Some patients may experience a combination of both types of pulmonary edema.

    Acute and Chronic Pulmonary Edema

    Pulmonary edema can also be classified as acute or chronic. Pulmonary edema that occurs suddenly is called acute pulmonary edema. It is a medical emergency and requires immediate treatment. Pulmonary edema that occurs slowly is called chronic pulmonary edema. It produces symptoms gradually.

    Cardiac causes: Pulmonary edema can occur in heart failure affecting the left side of the heart. It may be a consequence of conditions like heart attack, severe anemia or diseases of the heart valves. These conditions may cause increased pressure in the left atrium, which in turn is transmitted to the lung capillaries. The pressure pushes the fluid through the capillaries into the lung tissue.

    Non-cardiac causes: Non-cardiogenic pulmonary edema occurs due to conditions affecting the lungs either directly or indirectly. Causes of non-cardiogenic pulmonary edema include the following:

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  • Infections, damage to lungs caused by smoke or oxygen treatment, or aspiration of stomach contents into the lungs. These conditions increase capillary permeability.
  • Injury to the chest or other parts of the body due to trauma
  • Use of intravenous drugs of abuse like heroin
  • Excessive intravenous fluids, which increase capillary pressure
  • Side effects of medications like aspirin or chemotherapy used for cancer treatment
  • Pulmonary embolism, a condition where a clot, usually from the lower limbs, travels to the lungs
  • Travel to high altitudes where the air pressure is low
  • Neurogenic pulmonary edema, which occurs as a reaction to a condition affecting the nervous system like trauma, meningitis, etc.
  • Re-expansion pulmonary edema. This type of pulmonary edema occurs following treatment of pleural effusion or pneumothorax, which are conditions where fluid or air accumulates in the pleural space, respectively. On treatment of these conditions, a negative pressure is created in the chest, which could give rise to pulmonary edema.
  • Following surgical procedures like cardiopulmonary bypass
  • Obstruction of the upper airways, which creates negative pressure in the chest
  • Liver or kidney disease
  • Following multiple blood transfusions

    • Acute pulmonary edema produces sudden and severe symptoms. In contrast, symptoms may be more gradual in chronic pulmonary edema. The patient usually prefers to sit up or stand, rather than lie down so that it is easier to breathe. Symptoms and signs of pulmonary edema include the following:

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  • Breathlessness on exertion
  • Breathlessness on lying down and at night
  • Increase in heart rate
  • Cough with pink, frothy sputum
  • Excessive sweating
  • Feeling of drowning
  • Feeling of anxiety
  • Bluish color of the skin due to reduced oxygen content of blood. This condition is referred to as cyanosis.
  • Altered mental status due to low oxygen levels in the blood
  • Wheezing

    • Pulmonary edema is diagnosed based on history, physical examination and various tests. History obtained from the patients or relatives may help to detect the possible cause of the pulmonary edema. Physical examination may reveal sounds from the lungs that can be heard with a stethoscope. Tests are used to confirm the presence of fluid in the lungs and to detect the underlying cause of the edema. Some of these include:

    Chest X-ray

    Chest X-ray may show changes consistent with the presence of fluid in the lungs

    CT Scan

    CT scan of the chest is more accurate in diagnosing changes in the lung associated with pulmonary edema

    Pulse oximetry and arterial blood gas analysis

    These tests are done to estimate the oxygen level in the blood

    B-type natriuretic peptide and N-terminal proBNP (NT-proBNP)

    B-type natriuretic peptide and NT-proBNP levels in the blood may be high in patients with a heart problem. These are normally produced by the heart muscles.

    Pulmonary artery catheterization

    This test measures the pressure in the pulmonary capillaries. It helps to differentiate between cardiogenic and non-cardiogenic pulmonary edema.

    ECG and Echocardiography

    These tests will help to identify any cardiac problems that may be responsible for the pulmonary edema

    Other tests to identify underlying conditions like tests for liver and kidney function, blood tests for anemia etc.

    A pulmonary edema patient is placed on a bed with the head end slightly raised. Treatment of pulmonary edema includes the following:

  • Restore the oxygen level in the blood. Oxygen is administered to ensure adequate supply to various tissues of the body. If oxygen administration does not improve the condition, positive-pressure ventilation may be used.
  • Treat the underlying cause. Medications may be administered depending on the underlying cause

    • In addition, treatment of cardiogenic pulmonary edema may include the following:

  • Medications to increase elimination of fluids from the body, relax blood vessels, increase contraction of the heart and treat abnormal heart rhythm.
  • Intraaortic balloon counterpulsation, which may be used in patients with heart failure. In this procedure, a balloon on a catheter is inserted up to the aorta. Inflation and deflation of the balloon help to improve cardiac function and stabilize the patient before definitive surgical procedure can be carried out.

    • Some ways to prevent pulmonary edema include the following:

  • Keep your heart healthy with a good diet and regular exercise
  • Heart patients should control their salt intake
  • Treat conditions like hypertension and high cholesterol; take medications on a regular basis as advised by the doctor
  • Avoid smoking
  • Climbing to high altitudes should be gradual. The person should be well acclimatized before climbing. Certain medications may be given before travel to high altitudes to prevent pulmonary edema

    • What Causes Pulmonary Edema, Or Fluid In The Lungs?

    The Seychelles News Agency reports that an autopsy found that two vacationing American sisters  died from acute pulmonary edema, or fluid in their lungs.

    According to the Mayo Clinic's website, pulmonary edema is usually cardiogenic — that is, related to a weakness or malfunction of the heart.

    Noncardiogenic causes can include:

  • Pneumonia or other infection
  • High altitude
  • Reaction to drugs
  • Inhalation of a toxin, smoke or water
  • Brain injury
  • Trauma to the lung or chest wall

    • Originally Published: September 30, 2016 at 11:55 AM PDT


    Pulmonary Edema: Key Warning Signs - MadameNoire

    Pulmonary edema is a critical condition where fluid accumulates in the lungs, causing leakage from blood vessels into air sacs normally filled with air for oxygen exchange. This accumulation impedes breathing and reduces oxygen transfer into the bloodstream. 

    Michael Arterburn, who goes by @killer_bee_tactical on Instagram, highlighted the dangers of pulmonary edema in a post on May 10. He referenced the tragic case of Ray Johnson, a 64-year-old from Michigan who allegedly developed the condition and died in February 2022 after snorkeling in Maui.

    Although officially ruled a drowning, Johnson's lawyers argue he succumbed to rapid onset pulmonary edema—a severe variant where the lungs fill rapidly with fluid, compromising oxygen delivery and leading to hypoxia, Fox News reported.

    What causes pulmonary edema?

    Per Healthline, pulmonary edema can manifest suddenly or develop gradually, with its presentation varying depending on the underlying cause. Congestive heart failure stands as a frequent instigator of this condition and can occur when the heart fails to effectively circulate blood, leading to elevated pressure in the lungs' small blood vessels and subsequent fluid leakage. Normally, the lungs absorb oxygen from inhaled air into the bloodstream, but when fluid accumulates, this vital exchange falters, depriving the body of essential oxygen.

    Additional contributing medical conditions encompass heart attacks, valve disorders, cardiomyopathy, irregular heart rhythms, sudden hypertension, pneumonia, renal failure and severe infections like sepsis. Factors such as higher rates of certain chronic conditions like hypertension, diabetes and heart disease may increase the risk of developing conditions like pulmonary edema in Black people.

    As highlighted in Arterburn's video, in the case of Johnson, investigators believe that high-altitude exposure played a role in his fatal rapid-onset pulmonary edema.

    High-altitude pulmonary edema (HAPE) can strike adults and children alike during high-altitude travel or within individuals who engage in vigorous exercise at great heights, Arterburn mentioned. Its symptoms resemble those of acute pulmonary edema, including headaches followed by increasing breathlessness, initially with exertion and then even at rest. Reduced stamina is noticeable, accompanied by a dry cough that may transition to a productive cough producing frothy sputum, sometimes tinged pink or streaked with blood as the condition progresses.

    Johnson's legal representatives believe his death might have been avoidable if he had waited three days after flying before snorkeling, allowing his lungs to acclimate. Studies show that tourists typically endure at least five hours of flight time to reach Hawaii, where airplane cabins are pressurized to altitudes equivalent to up to 8,500 feet. This pressurization can impact lung membrane permeability, potentially increasing the risk of conditions like rapid onset pulmonary edema, Fox News noted.

    Additionally, the swimmer's horizontal stance in the water coupled with the constriction of their snorkel tube imposes resistance that can hamper the flow of oxygen. Swimming itself demands considerable physical effort which can also increase risk. 

    If you're flying to a tropical destination this summer, it's advisable to wait a few days before participating in water activities. Be vigilant for symptoms of pulmonary edema, such as:

  • Shortness of breath during physical exertion
  • Difficulty breathing while lying down
  • Wheezing
  • Waking up at night feeling breathless, relieved upon sitting up
  • Sudden weight gain, particularly in the legs
  • Swelling (edema) in the lower body
  • Fatigue

    • RELATED CONTENT: How Heart Attack Symptoms Show Up Differently In Women





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