What Is Symptomatic Pulmonary Congestion?
Pulmonary congestion (pulmonary edema) is a condition in which there is excess fluid built up in the air sacs of the lungs. Symptomatic pulmonary congestion indicates the condition is showing symptoms. Pulmonary congestion is a serious condition that can lead to fatal consequences, so rapid intervention is necessary.
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Symptoms
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Symptoms of symptomatic pulmonary congestion include severe shortness of breath, difficulty breathing, feeling of drowning or suffocating, wheezing, anxiety or restlessness, cough that produces sputum with or without blood, excess sweating, pale skin, chest pain (if caused by heart disease) and heart palpitations. Other symptoms that develop gradually include increased shortness of breath during physical activity, difficulty breathing with exertion (especially when lying flat), waking up at night with a feeling of breathlessness that goes away when sitting up, rapid weight gain, loss of appetite and fatigue.
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Causes
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Pulmonary congestion is caused by the alveoli (air sacs in the lungs) filling with fluid instead of air. Etiology can be from multiple aspects. The cardiac cause of pulmonary congestion is congestive heart failure, which occurs when the left ventricle of the heart is not able to pump out enough blood that is received from the lungs. Noncardiac causes include lung infections, toxins, kidney disease, smoke inhalation, adverse drug reaction, acute respiratory distress syndrome (ARDS) and high altitudes.
Diagnosis
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Pulmonary congestion requires immediate attention, so initial diagnosis generally includes a history, physical examination and chest X-ray. Blood taken from an artery in the left wrist can check oxygen and carbon dioxide levels as well as a substance known as B-type natriuretic peptide (BNP). Elevated BNP levels indicate a cardiac cause. An electrocardiography (ECG) may be performed through patches on the skin that receive electrical impulses from the heart. These impulses can indicate decreased blood flow. An echocardiography or transesophageal echocardiography (TEE) test uses a wand-shaped device to generate high-frequency sound waves that compose images of your heart on a monitor, testing for a wide range of cardiac causes. Pulmonary artery catheterization and cardiac catheterization may also be performed to measure pressure.
Risks
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If pulmonary congestion is not treated immediately, the pressure in the pulmonary artery can raise, causing the right ventricle of the heart to fail. The right ventricle is much thinner than the left ventricle. If the increased pressure backs up in the right atrium and other parts of the body it can cause leg edema (swelling), ascites (abdominal swelling), pleural effusion (fluid in the membranes surrounding the lungs) and congestion and swelling of the liver. Acute pulmonary congestion can be fatal.
Treatment
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Oxygen through a mask or nasal cannula is a front-line treatment for symptomatic pulmonary congestion. Preload reducers are medications that dilate the veins in the body, decreasing fluid pressure in the heart and lungs. Morphine can treat shortness of breath and anxiety. Afterload reducers dilate peripheral vessels and takes a pressure load off of the left ventricle. High-altitude pulmonary edema (HAPE) is generally treated by descending a few thousand feet, oxygen or helicopter rescue.
References
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