Diagnosis

Because pulmonary edema requires prompt treatment, you'll initially be diagnosed on the basis of your symptoms and a physical exam, electrocardiogram and chest X-ray.

Once your condition is more stable, your doctor will ask about your medical history, especially whether you have ever had cardiovascular or lung disease.

Tests that may be done to diagnose pulmonary edema or to determine why you developed fluid in your lungs include:

  • Chest X-ray. A chest X-ray will likely be the first test you have done to confirm the diagnosis of pulmonary edema and exclude other possible causes of your shortness of breath.
  • Pulse oximetry. In pulse oximetry, a sensor attached to your finger or ear uses light to determine how much oxygen is in your blood.
  • Blood tests. You may have blood drawn, usually from an artery in your wrist, so that it can be checked for the amount of oxygen and carbon dioxide it contains (arterial blood gas concentrations).

    Your blood may also be checked for levels of a substance called B-type natriuretic peptide (BNP). Increased levels of BNP may indicate that your pulmonary edema is caused by a heart condition.

    Other blood tests may be done — including tests of your kidney function, thyroid function and blood count — as well as tests to exclude a heart attack as the cause of your pulmonary edema.

  • Electrocardiogram (ECG). This noninvasive test can reveal a wide range of information about your heart. During an ECG, patches attached to your skin receive electrical impulses from your heart. These are recorded in the form of waves on graph paper or a monitor. The wave patterns show your heart rate and rhythm and whether areas of your heart show diminished blood flow.
  • Echocardiogram. An echocardiogram is a noninvasive test that uses a wand-shaped device called a transducer to generate high-frequency sound waves that are reflected from the tissues of your heart. The sound waves are then sent to a machine that uses them to compose images of your heart on a monitor.

    The test can help diagnose a number of heart problems, including heart valve problems, abnormal motions of the ventricular walls, fluid around the heart (pericardial effusion) and congenital heart defects.

    It can also show areas of diminished blood flow in your heart and if your heart pumps blood effectively when it beats. It can also estimate if there's increased pressure in the right side of the heart and increased pressure in the pulmonary arteries.

  • Transesophageal echocardiography (TEE). In a traditional cardiac ultrasound exam, the transducer remains outside your body on the chest wall. But in TEE, a doctor inserts a soft, flexible tube (catheter) with a transducer attached to the tip through your mouth and guides it into your esophagus — the passage leading to your stomach.

    The esophagus lies immediately behind your heart, which allows your doctor to see a closer and more accurate picture of your heart and central pulmonary arteries.

  • Pulmonary artery catheterization. If other tests don't reveal the reason for your pulmonary edema, your doctor may suggest a procedure to measure the pressure in your lung capillaries (wedge pressure).

    During this test, a doctor inserts a small, balloon-tipped catheter through a vein in your leg or arm and guides it into a pulmonary artery. The catheter has two openings connected to pressure transducers. The balloon is inflated and then deflated, giving pressure readings.

  • Cardiac catheterization. If tests such as an ECG or echocardiography don't uncover the cause of your pulmonary edema, or you also have chest pain, your doctor may suggest cardiac catheterization and coronary angiogram.

    During cardiac catheterization, a doctor inserts a long, thin catheter in an artery or vein in your groin, neck or arm and threads it through your blood vessels to your heart using X-ray imaging. Doctors then inject dye into the blood vessels of your heart to make them visible under X-ray imaging (coronary angiogram).

    During this procedure, doctors can perform treatments such as opening a blocked artery, which may quickly improve the pumping action of your left ventricle. Cardiac catheterization can also be used to measure the pressure in your heart chambers, assess your heart valves and look for causes of pulmonary edema.

Treatment

Giving oxygen is the first step in the treatment for pulmonary edema. You usually receive oxygen through a face mask or nasal cannula — a flexible plastic tube with two openings that deliver oxygen to each nostril. This should ease some of your symptoms. Your doctor will monitor your oxygen level closely. Sometimes it may be necessary to assist your breathing with a machine such as a mechanical ventilator.

Depending on your condition and the reason for your pulmonary edema, you may also receive one or more of the following medications:

  • Preload reducers. Preload reducing medications decrease the pressure caused by fluid going into your heart and lungs. Doctors commonly prescribe nitroglycerin and diuretics such as furosemide (Lasix) to treat pulmonary edema. Diuretics may make you urinate so much initially that you may temporarily need a urinary catheter while you're in the hospital. The drug nifedipine (Procardia) may sometimes be prescribed.
  • Morphine (Avinza, MS Contin). This narcotic may be used to relieve shortness of breath and anxiety. But some doctors believe that the risks of morphine may outweigh the benefits and are more apt to use other more-effective drugs.
  • Afterload reducers. These medications, such as nitroprusside (Nitropress), dilate your blood vessels and take a pressure load off your heart's left ventricle.
  • Blood pressure medications. If you have high blood pressure when you develop pulmonary edema, you'll be given medications to control it. Alternatively, if your blood pressure is too low, you're likely to be given medications to raise it.

If your pulmonary edema is caused by another condition such as a nervous system condition, your doctor will treat the condition that is causing it and the pulmonary edema.

Treating high-altitude pulmonary edema (HAPE)

If you're climbing or traveling at high altitudes and experience mild symptoms of HAPE, descending 2,000 to 3,000 feet (about 600 to 900 meters) as quickly as you can, within reason, should relieve your symptoms. You should also reduce physical activity and keep warm, as physical activity and cold can make your condition worse.

Oxygen is usually the first treatment and can often relieve your symptoms. If supplemental oxygen isn't available, you may use portable hyperbaric chambers, which imitate a descent for several hours until you can descend to a lower elevation.

In addition to oxygen and descending to a lower elevation, the medication nifedipine (Procardia) may help reduce pressure in the pulmonary arteries and improve your condition.

When symptoms are more severe, you'll likely need help in your descent. A helicopter rescue may be necessary for the most serious cases because HAPE can be life-threatening.

Some climbers take prescription medications such as acetazolamide (Diamox Sequels) or nifedipine to help treat or prevent symptoms of HAPE. To prevent HAPE, medication is started at least one day before ascent.

Lifestyle and home remedies

Depending on your condition, your doctor may recommend lifestyle changes, including:

  • Controlling your high blood pressure. If you have high blood pressure, take your medications as prescribed and check your blood pressure regularly. Record the results. Ask your doctor for guidelines regarding your optimal blood pressure.
  • Controlling other medical conditions. Control any underlying medical conditions, such as controlling your glucose levels if you have diabetes.
  • Avoiding the cause of your condition. If your condition is due to drugs, allergens or high altitudes, avoid these to minimize further damage to your lungs.
  • Quitting smoking. If you smoke, quit smoking.
  • Eating a healthy diet. Your doctor may recommend that you follow a low-salt diet. Ask for a referral to a dietitian if you need help evaluating the salt content in foods. Also eat a healthy diet of fruits, vegetables and whole grains.
  • Maintaining a healthy weight and exercising. Maintain a healthy weight and exercise regularly.

Preparing for your appointment

If you have pulmonary edema, you will likely first be seen by an emergency room doctor. If you think you have signs or symptoms of pulmonary edema, call 911 or emergency medical help rather than make an outpatient appointment.

Most people with pulmonary edema will be hospitalized for at least a few days, often longer. You may see several specialists while you're in the hospital. After your condition has been stabilized, you may then be referred as an outpatient to a doctor trained in heart conditions (cardiologist) or lung conditions (pulmonologist).

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down if you have had similar symptoms in the past, even if you didn't see a doctor.
  • Write down key personal information, including any major stresses or recent life changes.
  • Obtain copies of medical records whenever possible. Discharge summaries from the hospital, results from heart tests, as well as summary letters from any previous specialists you've seen can be helpful for your new doctor.
  • Make a list of all medications as well as any vitamins or supplements that you're taking.
  • Keep written track of your weight, and take that record with you so that your doctor can look for any trends.
  • Make a list of the salty foods you eat regularly. Mention if you have eaten more of these recently.
  • Ask a family member or friend to come along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For pulmonary edema, some basic questions to ask your doctor include:

  • What's the most likely cause of the symptoms I'm currently experiencing?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • What do my chest X-ray and electrocardiogram show?
  • What treatments are available, and which do you recommend?
  • What types of side effects can I expect from treatment?
  • Are there any alternatives to the primary approach that you're suggesting?
  • What's my prognosis?
  • Are there any dietary or activity restrictions that I need to follow? Would it help to see a dietitian?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous?
  • Have you eaten more salty foods lately?
  • How severe are your symptoms? Have your symptoms affected your work or daily activities?
  • Do you have any symptoms of obstructive sleep apnea?
  • Have you been diagnosed with obstructive sleep apnea? If so, what are you doing for it?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have any family history of lung or heart disease?
  • Have you ever been diagnosed with chronic obstructive pulmonary disease (COPD) or asthma?
  • Do you smoke or did you smoke in the past? If so, how many packs a day and when did you quit?
  • What kind of exercise do you do?
  • Do you travel to altitudes higher than 1 mile?
July 24, 2014
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