Pulmonary Edema

Diagnosis

Breathing difficulties require prompt evaluation. A health care provider can diagnose pulmonary edema based on symptoms, a physical exam and specific tests. Once the condition becomes more stable, the provider may review medical history, especially any history of heart or lung disease.

Tests that help diagnose pulmonary edema or identify the cause of fluid buildup in the lungs include:

• Chest X-ray to confirm pulmonary edema and rule out other causes of shortness of breath.

• Chest computerized tomography (CT) scan to give detailed images of the lungs and help diagnose or exclude pulmonary edema.

• Pulse oximetry using a sensor attached to the finger or ear to measure oxygen levels in the blood.

• Arterial blood gas test to measure oxygen and carbon dioxide levels in the blood.

• B-type natriuretic peptide (BNP) blood test, as high BNP levels may indicate a heart-related cause.

• Other blood tests, including a complete blood count, metabolic panel to check kidney function and thyroid function test.

• Electrocardiogram (ECG or EKG) to detect the timing and strength of the heart’s signals. Electrodes placed on the chest and sometimes the limbs show heart rhythm and can identify thickened heart walls or previous heart attacks. A portable device such as a Holter monitor may be used at home for continuous monitoring.

• Echocardiogram, which uses sound waves to create images of the heart. It can show heart valve problems, weak heart muscle and fluid around the heart.

• Cardiac catheterization and coronary angiogram, used when other tests do not determine the cause or when chest pain is present. Dye injected through a catheter helps show blockages in the heart arteries.

• Ultrasound of the lungs, a quick and painless test that can show fluid buildup and pleural effusions.

Treatment

Oxygen is the first treatment for acute pulmonary edema. It is delivered through a face mask or nasal cannula to reduce symptoms. The oxygen level is closely monitored, and in some cases, assisted breathing with a machine such as a mechanical ventilator or a positive airway pressure device may be necessary.

Depending on the cause and severity of pulmonary edema, treatment may include:

• Diuretics such as furosemide to reduce pressure from excess fluid in the heart and lungs.

• Blood pressure medicines to manage high or low blood pressure. Some medications lower the pressure entering or leaving the heart, including nitroglycerin and nitroprusside.

• Inotropes given through an IV for severe heart failure. These improve heart pumping ability and maintain blood pressure.

• Morphine taken orally or by IV to ease shortness of breath and anxiety, though some providers prefer safer alternatives.

It is important to diagnose and treat any nervous system issues or causes of heart failure that contribute to pulmonary edema.

Treating high-altitude pulmonary edema (HAPE)

Oxygen is typically the first treatment. If oxygen is unavailable, a portable hyperbaric chamber can mimic moving to a lower altitude until descent is possible.

Treatments for high-altitude pulmonary edema include:

• Immediately descending 1,000 to 3,000 feet, which helps relieve symptoms. Severe cases may require rescue assistance.

• Stopping physical activity and keeping warm, as cold and exertion can worsen symptoms.

• Medication such as acetazolamide or nifedipine, which some climbers use to treat or prevent HAPE. These medicines are started at least a day before ascending to higher elevations when used for prevention.