Cardiogenic Pulmonary Edema - Causes, Symptoms and Treatment

Introduction

Cardiogenic pulmonary edema is a clinical condition resulting from a collection of excess fluid in the lungs due to cardiac dysfunction. It results in breathing difficulty due to the accumulation of fluids in the lungs’ air sacs. Edema refers to any kind of swelling due to a collection of particular fluid, whereas anything related to the lungs is called pulmonary. In individuals with cardiac diseases, pulmonary edema is a common finding. Other clinical conditions resulting in pulmonary edema are exposure to certain medications, traumatic injury to the chest wall, or traveling to higher altitudes. The sudden appearance of pulmonary edema calls for a medical emergency requiring immediate medical care. Generally, treatment depends on the cause, but the primary line of therapy is oxygen and medications.

What Are the Causes of Cardiogenic Pulmonary Edema?

There are multiple underlying cardiovascular conditions that may lead to the development of cardiogenic pulmonary edema. Below mentioned are some of them.

• Cardiomyopathy is a condition of muscle damage in the heart called myocardium. It results in a reduction of pumping activity of the heart in conditions of exercise, infection, or an increase in blood pressure. Fluids tend to collect in the lungs because of the failure of the ventricle.

• Coronary artery disease refers to the fatty deposits in the heart arteries that reduce and narrowing of the coronary arteries. This weakens the heart's left ventricle. A heart with damaged muscle loses efficiency to pump blood. Heart muscles get damaged because of blockage by a blood clot resulting in a heart attack.

• High blood pressure or hypertension.

• Heart valve problems when developed, blood flow is severely affected by the valves of the heart—narrowing results in improperly closing valves and decreasing blood flow in the heart.

• Narrowing of kidney arteries results in a build-up of fluid in lung sacs resulting in pulmonary edema.

What Are The Signs and Symptoms Of Cardiac Pulmonary Edema?

Pulmonary edema results from leakage from the valve and sudden fluid collection in the lungs' air sacs. The heart has to pump harder in these conditions, thus increasing blood pressure.

Signs and symptoms vary depending on the type of pulmonary edema. Pulmonary edema can present with sudden movements of long-standing and may appear suddenly or develop over time.

• Extreme shortness of breath.

• Difficulty in breathing.

• Lying down induces a feeling of suffocation or drowning.

• Presence of frothy sputum on coughing.

• Presence of bloodstains in the cough.

• Gasping.

• Wheezing.

• Restlessness.

• Anxiety.

• A sense of apprehension.

• Bluish discoloration of the lip.

• The heartbeat is rapid.

• Disturbed sleep.

• Increased shortness of breath with increased physical activity.

• Rapid gain in body weight.

• Presence of swelling in lower limbs.

• Swelling of the abdomen.

• Headache.

• Irregular heartbeat.

• Fatigue.

• Chest pain.

• Fever of low grade.

• Bubbly sound during breathing.

• Pink sputum.

• Confusion.

• Altered mental state.

• Low blood pressure.

• Dizziness.

• Increased sweating.

• Fatigue.

• Lightheadedness.

What Are the Risk Factors of Cardiogenic Pulmonary Edema?

Cardiac stress increases in the gut when an affected ventricle cannot pump enough blood from the lungs. Heart failure and other related heart conditions that raise the pressure in the heart increase the risk of pulmonary edema. Risk factors for an episode of heart failure include the following mentioned below.

• Abnormal heart rhythms (arrhythmias).

• Alcohol use.

• Congenital heart disease.

• Coronary artery disease.

• Diabetes.

• Heart valve disease.

• High blood pressure.

• Sleep apnea.

How to Diagnose Cardiogenic Pulmonary Edema?

There are no specific tests for cardiogenic pulmonary edema. The preferred choice is to start from basic to more advanced examinations to reach the correct diagnosis and etiology. After a preliminary diagnosis of pulmonary edema based on signs and symptoms, further diagnostic tests are done to detect the presence of fluids in the lungs.

• Chest computed tomography can give indirect clues to help diagnosis but does not help make a final diagnosis.

• Chest X-ray is responsible for the confirmatory test for pulmonary edema.

• An arterial blood test is done to check the amount of oxygen and carbon dioxide in the arterial blood.

• Pulse oximetry is used to check oxygen saturation in the blood.

• An electrocardiogram or EKG is used to detect abnormal signals that may indicate a previous heart attack history.

• An echocardiogram is used to diagnose poor blood flow in the heart and abnormal heart muscles and valves.

• Ultrasound of the lungs is also a valuable tool to find the amount of fluid collected in the lungs because of the poor functioning of muscles and valves.

• Angiogram of the coronary artery.

• Cardiac catheterization is done by inserting a long tube in a vein or artery of the neck, arm, or groin region. It helps to reveal the pressure in heart chambers and thus show any blockages present.

What Is the Treatment of Cardiogenic Pulmonary Edema?

Cardiogenic pulmonary edema results from increased pressure in the heart, which pushes fluid in air sacs from blood vessels. Management in cardiogenic pulmonary edema (CPE) starts with the initial management by addressing the ABCs (airway, breathing, circulation) of resuscitation. First and foremost is providing supplemental oxygen through a face mask and cannula. The doctor will monitor oxygen levels and sometimes use me. Ventilatory support and medical treatment are required in hypoxic or patients in respiratory distress.

• Cardiogenic pulmonary edema results in increased blood pressure. In such cases, Nitroglycerin and Nitroprusside are drugs of choice.

• Diuretics such as Furosemide are used to decrease the pressure built by fluid in the lungs.

• Inotropes are administered through an intravenous route in a hospital setup. It is used to improve the heart's pumping and maintain blood pressure.

• Reducing the pulmonary venous return.

• Decreasing the vascular resistance.

• Increasing cardiac output by increasing cardiac contractility.

Conclusion

Cardiogenic pulmonary edema is a medical emergency that may result in a life-threatening condition. Management requires an interdisciplinary approach for better outcomes. Patients should be motivated to quit smoking, join cardiac rehabilitation groups, maintain a healthy lifestyle to control body weight, check on physical activity, and comply appropriately with follow-up and medications. A well-coordinated focused approach to patient care in all interdisciplinary departments is necessary for improved patient care. Apart from the physician, a multispecialty team involving pulmonologists, cardiologists, and cardiothoracic surgeons is essential.