Pulmonary edema

Signs and Symptoms

Symptoms may start suddenly and get worse quickly. They include:

• Extreme shortness of breath and trouble breathing
• Tightness and pain in the chest
• Wheezing, coughing
• Paleness
• Sweating
• Bluish nails and lips
• Pink, frothy mucus coming from nose and mouth

If pulmonary edema is related to congestive heart failure, symptoms may come on more slowly. You may notice shortness of breath when you are lying down, quick weight gain from retaining fluid, and fatigue.

What Causes It?

The most common cause of pulmonary edema is heart failure. But not every case is due to heart problems. Other risk factors for pulmonary edema include:

• Acute, severe asthma
• High blood pressure, including preeclampsia
• Diabetes
• Coronary or valvular heart disease
• Obesity
• Being at a high altitude, especially exercising
• Central nervous system injury
• Infection, including pneumonia
• Hanta virus
• Breathing in toxins
• Having a blood transfusion
• Tonsilectomy

What to Expect at Your Doctor's Office

Pulmonary edema that happens suddenly is life threatening and needs emergency treatment. Once the initial attack is under control, your doctor will order blood tests and a urine test to find out what caused the attack.

Other tests may include:

• Chest x-ray
• Electrocardiogram
• Echocardiogram
• Transesophageal echocardiogram
• Cardiac catheterization

If you are in the hospital, you will be given oxygen.

Treatment Options

Medications may include diuretics (water pills) to get rid of excess fluid in your lungs, blood pressure medication, and drugs to dilate blood vessels. In rare cases, surgery may be needed. Noninvasive, positive pressure ventilation (NPPV) and continuous positive airway pressure (CPAP) may help treat acute cardiogenic pulmonary edema.

Complementary and Alternative Therapies

Pulmonary edema should be treated with conventional medications. Complementary and alternative therapies (CAM) may be used with your doctor's permission, helping to strengthen your heart and lungs. But they should never be used by themselves to treat pulmonary edema. Make sure to tell your doctors about any CAM therapies or supplements you may be using.

Depending on what kind of diuretic you take, you may need to get more potassium and magnesium in your diet -- for example, by eating bananas, apricots, nuts, seeds, and green leafy vegetables. Your doctor may also suggest that you take a supplement. With other kinds of diuretics, you may need to make sure you do not get too much potassium. Ask your doctor if you need more magnesium and potassium, or if you need to make other changes to your diet.

• Coenzyme Q10 (CoQ10). Is good for heart health. Several studies suggest that CoQ10 supplements can help reduce swelling in the legs, help breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure. Not all studies agree, however. DO NOT take CoQ10 if you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix) or aspirin. CoQ10 can make blood thinners less effective.
• L-carnitine. Improves endurance and is good for heart health. Carnitine is a nutrient that helps the body convert fatty acids into energy, which is then used primarily by your muscles. If you take blood-thinners or thyroid hormone, ask your doctor before taking carnitine. People with a history of seizures should not take l-carnitine.
• Magnesium. Helps your heart work better and may help treat congestive heart failure. In addition, some diuretics (water pills) may cause your body to lose too much magnesium. For this reason, your doctor may recommend a supplement. Magnesium and calcium work together to help your heart function. So it is important to ask your doctor before taking either magnesium or calcium supplements. Both interact with many medications, herbs, and supplements.
• Potassium. Helps the heart muscle contract. If you take a certain kind of diuretic, your doctor may tell you to take a potassium supplement. Your doctor will tell you how much to take. DO NOT take potassium on your own, however -- if you take another kind of diuretic then taking a potassium supplement could be dangerous. Ask your doctor before taking extra potassium.
• Vitamin E and vitamin C. Are antioxidants that may promote heart health, although evidence is mixed. Vitamin E can increase the risk of bleeding, especially if you already take blood thinners. Vitamin E may interact with a number of medications. So ask your doctor before taking it.
• Thiamine (vitamin B1). May improve heart function in people with heart failure, although studies show mixed results. Also, diuretics (water pills) can cause your body to lose too much thiamine. Talk to your doctor about measuring your level of vitamin B1 and whether you should take thiamine.
• L-arginine and taurine, which are amino acids. May improve heart function in people with heart failure. Be sure to ask your doctor before taking l-arginine, because it may interfere with other treatments and may not be right for you. L-arginine can affect circulation and blood pressure. It may also aggravate herpes infections. Taurine may act like a diuretic. So, DO NOT take it if you already take a diuretic (water pill) or if you take lithium.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Ask your doctor before taking herbs for pulmonary edema.

For pulmonary edema that does not start with the heart:

• Garlic (Allium sativum). Helps you cough up mucus, may slightly lower blood pressure, and stimulates your immune system. Garlic may increase the risk of bleeding, especially if you take blood-thinning medication (anticoagulants). If you take blood thinners, such as warfarin (Coumadin), ask your doctor before taking garlic. Garlic may also interact with a number of other medications, including medications used to treat HIV and birth control pills.
• Rosemary (Rosmarinus officinalis). May help the body get rid of excess fluid. DO NOT take rosemary if you take diuretics (water pills). Some herbalists believe rosemary can potentially interact with blood-thinning medications, such as warfarin (Coumadin), among others.
• Horse chestnut (Aesculus hippocastanum). May help the body get rid of excess fluid. Horse chestnut may contain toxic chemicals. So be sure to use a trusted brand. DO NOT use horse chestnut if you already take a diuretic, have liver or kidney disease, take blood thinners (anticoagulants), or are allergic to latex. DO NOT take more than the recommended dosage.
• Horsetail (Equisetum arvense). Traditionally used as a diuretic to help the body get rid of excess fluid. DO NOT take horsetail if you already take a diuretic, or have high blood pressure or heart disease. Take it only under the supervision of a doctor.

For pulmonary edema originating with the heart, especially heart failure, the following herbs may help. It is important to get a diagnosis and work closely with your doctor to see which herbs may be right for your condition. DO NOT take these herbs on your own.

• Hawthorn (Crataegus monogyna). Used in many types of heart disease. Several scientific studies suggest that hawthorn improves the heart's ability to pump blood in people with heart failure. It also significantly improved symptoms (like reduced shortness of breath and fatigue) and helped people exercise longer. Hawthorn interacts with many drugs taken to treat heart disease, high blood pressure, and heart failure.
• Linden (Tilia cordata). May help the body get rid of excess fluid. DO NOT take linden if you take diuretics (water pills) or lithium.
• Forskolin (Coleus forskohlii). People who take nitrates or nitroglycerin, or drugs called calcium channel blockers, such as diltiazem (Cardizem, Dilacor, Tiazac), nifedipine (Procardia), and verapamil (Calan, Verelan), should not take forskolin. Forskolin may increase the risk of bleeding, especially if you already take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Astragalus (Astragalus membranaceus). Helps the body get rid of excess fluid. The dose should be determined by your doctor. DO NOT take astragalus if you take diuretics (water pills), lithium, or cyclophosphamide. People with autoimmune diseases, such as rheumatoid arthritis and lupus, should not take astragalus.
• Ginkgo (Ginkgo biloba). May help improve circulation and heart function. DO NOT take ginkgo if you take blood thinners (anticoagulants), have diabetes, or have a history of seizures. Gingko interacts with many medications. So ask your doctor before taking it.

Homeopathy may help in addition to conventional treatment.

Alternating hot and cold applications with hand or foot baths may help circulation. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times to complete one set. Do 2 to 3 sets per day. Ask your doctor before starting this treatment. It may not be right for everyone.

Being active or exercising helps your body get rid of excess fluid. Ask your doctor about the level of physical activity that would be safe and beneficial for you.

Castor oil pack. Apply oil directly to the chest, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack, and let sit for 30 to 60 minutes. Repeat 4 to 6 times per week.

Acupuncture may improve heart and lung function.

Massage can help increase circulation.

Following Up

If you have congestive heart failure, you will need to work closely with your doctor to manage your symptoms.

Special Considerations

Pregnant women who are obese and have high blood pressure are at higher risk for pulmonary edema. People with heart failure may have complications, including sleep apnea, pulmonary edema, and pleural effusions.

Supporting Research

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