Diagnosis

Breathing problems require immediate diagnosis and treatment. Your doctor can make a preliminary diagnosis of pulmonary edema based on your signs and symptoms and the results of a physical exam, electrocardiogram and chest X-ray.

Once your condition is more stable, your doctor will ask questions 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 can confirm the diagnosis of pulmonary edema and exclude other possible causes of your shortness of breath. It's usually the first test done when someone has signs or symptoms of pulmonary edema.
  • Chest CT. A computed tomography (CT) scan of the chest may not provide the cause for the pulmonary edema, but can give your doctor indirect clues to help make a diagnosis.
  • Pulse oximetry. A sensor is attached to your finger or ear and uses light to determine how much oxygen is in your blood.
  • Arterial blood gas test. Blood is taken, usually from an artery in your wrist, and checked for the amount of oxygen and carbon dioxide it contains (arterial blood gas concentrations).
  • B-type natriuretic peptide (BNP) blood test. Increased levels of BNP may signal a heart condition.
  • Other blood tests. Blood tests to diagnose pulmonary edema and its causes also usually include a complete blood count, metabolic panel to check kidney function and thyroid function test.
  • Electrocardiogram (ECG or EKG). This painless test detects and records the timing and strength of your heart's signals using small sensors (electrodes) attached to the skin on your chest and legs. The signals are recorded in the form of waves on graph paper or a monitor. An ECG can show signs of heart wall thickening or previous heart attack. A portable ECG machine such as a Holter monitor may be used to continuously monitor your heartbeat at home.
  • Echocardiogram. An echocardiogram creates a moving picture of your heart using sound waves (ultrasound). It can identify areas of poor blood flow, abnormal heart valves and heart muscle that is not working normally. Your doctor can use this test to help diagnose fluid around the heart (pericardial effusion).
  • Cardiac catheterization and coronary angiogram. This test may be done if an ECG, echocardiogram or other tests don't show the cause of pulmonary edema, or if you also have chest pain.

    During cardiac catheterization, a doctor inserts a long, thin tube (catheter) in an artery or vein in your groin, neck or arm. X-rays help guide the catheter through the blood vessel to your heart. During a coronary angiogram, dye flows through the catheter, allowing blood vessels to show up more clearly on the X-rays. A coronary angiogram can reveal any blockages and measure the pressure in your heart chambers.

  • Ultrasound of the lungs. This painless test uses sound waves to measure blood flow through the lungs. It can quickly reveal signs of fluid buildup and plural effusions. Lung ultrasound has become an accurate tool for diagnosing pulmonary edema.

Treatment

The first treatment for acute pulmonary edema is supplemental oxygen. 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 or one that provides positive airway pressure.

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

  • Diuretics. Doctors commonly prescribe diuretics, such as furosemide (Lasix), to decrease the pressure caused by excess fluid in your heart and lungs.
  • Morphine (MS Contin, Oramorph, others). This narcotic may be taken by mouth or given through an IV to relieve shortness of breath and anxiety. But some doctors believe that the risks of morphine may outweigh the benefits and are more likely to use other drugs.
  • Blood pressure drugs. If you have high or low blood pressure when you develop pulmonary edema, you'll be given medications to help manage the condition. Your doctor may also prescribe medications that lower the pressure going into or out of your heart. Examples of such medicines are nitroglycerin (Nitromist, Nitrostat, others) and nitroprusside (Nitropress).
  • Inotropes. This type of medication is given through an IV if you are in the hospital with severe heart failure. Inotropes improve heart pumping function and maintain blood pressure.

It is important to diagnosis and treat, if possible, any nervous system problems or causes of heart failure.

Treating high-altitude pulmonary edema (HAPE)

As with other forms of pulmonary edema, oxygen is the usually the first treatment. If supplemental oxygen isn't available, you may use portable hyperbaric chambers, which imitate a descent for several hours until you are able to move to a lower elevation.

Treatments for high-altitude pulmonary edema (HAPE) also include:

  • Immediately descending to a lower elevation. If you're climbing or traveling at high altitudes and have mild symptoms of HAPE, descend 1,000 to 3,000 feet (about 300 to 1,000 meters) as quickly as you can, within reason. Depending on the severity of your condition, you may need rescue assistance to get off the mountain.
  • Stop exercising and stay warm. Physical activity and cold can make pulmonary edema worse.
  • Medication. Some climbers take prescription medications such as acetazolamide or nifedipine (Adalat CC, Procardia) to help treat or prevent symptoms of HAPE. To prevent HAPE, medication is started at least one day before ascent.

Lifestyle and home remedies

Lifestyle changes are an important part of heart health and can help you manage some forms of pulmonary edema.

  • Keep blood pressure under control. If you have high blood pressure, take your medications as prescribed and check your blood pressure regularly. Record the results. Ask your doctor for your target blood pressure.
  • Manage other medical conditions. Address any underlying medical conditions, such as controlling your glucose levels if you have diabetes.
  • Avoid the cause of your condition. If pulmonary edema results from drug use or high altitudes, for example, you'll want to avoid these things to prevent further lung damage.
  • Don't smoke. It's always a healthy idea to stop smoking. If you need help quitting, talk to your doctor. He or she can provide tips and, sometimes, medications to help you quit smoking.
  • Eat less salt. Salt helps your body retain fluid. In some people with severely damaged left ventricular function, getting too much salt may be enough to trigger congestive heart failure. Your doctor may recommend a low-salt diet. If you need help, a dietitian can show you how to determine the salt content in foods and create a nutritious, good-tasting diet. In general, most people should consume less than 2,300 milligrams a day of salt (sodium). Ask your doctor what level is safe for you.
  • Choose a healthy diet. You'll want to eat a plenty of fruits, vegetables and whole grains. Limit saturated fats and trans fats, added sugars, and sodium.
  • Manage your weight. Being even slightly overweight increases your risk of cardiovascular disease. On the other hand, even losing small amounts of weight can lower your blood pressure and cholesterol and reduce your risk of diabetes.
  • Get regular exercise. Healthy adults should get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of the two. If you're not used to exercise, start out slowly and build up gradually. Be sure to get your doctor's OK before starting an exercise program.

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 making an outpatient appointment.

You may see several specialists while you're in the hospital. After you are stable, you may be referred 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 and 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 remember all of 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?
  • Have you been diagnosed with obstructive sleep apnea or do you have any symptoms of obstructive sleep apnea?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to make your symptoms worse?
  • 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?
  • Do you travel to altitudes higher than 1 mile?