Pulmonary edema is an abnormal build up of fluid in the lungs, which leads to swelling.

Pulmonary edema is usually caused by heart failure. As the heart fails, pressure in the veins going through the lungs starts to rise. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid interrupts normal oxygen movement through the lungs, resulting in shortness of breath.

Pulmonary edema may be caused by damage directly to the lung, such as that caused by poisonous gas or severe infection. Lung damage with a buildup of body fluid is also seen in kidney failure.

Pulmonary edema may also be a complication of a heart attack, leaking or narrowed heart valves (mitral or aortic valves), or any disease of the heart that results in weakening or stiffening of the heart muscle (cardiomyopathy).

• Anxiety
• Cough
• Difficulty breathing
• Excessive sweating
• Feeling of "air hunger" or "drowning" (if this occurs suddenly, awakening you from sleep and causing you to sit up and catch your breath, it's called "paroxysmal noctural dyspnea")
• Grunting or gurgling sounds with breathing
• Pale skin
• Restlessness
• Shortness of breath
• Shortness of breath when lying down (orthopnea) -- you may need to sleep with your head propped up or use extra pillows
• Wheezing

Additional symptoms that may be associated with this disease:

• Coughing up blood or bloody froth
• Decrease in level of awareness
• Inability to speak in full sentences
• Nasal flaring

The health care provider will perform a physical exam and use a stethoscope to listen to the lungs and heart. You may have:

• Crackles in the lungs or abnormal heart sounds
• Increased heart rate
• Pale or blue skin color
• Rapid breathing

Possible tests include:

• Blood oxygen levels -- low in patients with pulmonary edema
• Chest x-ray -- may reveal fluid in or around the lung space or an enlarged heart
• Electrocardiogram (ECG) -- to detect abnormal heart rhythm or evidence of a heart attack
• Ultrasound of the heart (echocardiogram) -- to see if there is a weak heart muscle, leaky or narrow heart valves, or fluid surrounding the heart

Oxygen is given through a face mask or tiny plastic tubes (prongs) placed in the nose. A breathing tube may be placed into the windpipe (trachea). A breathing machine (ventilator) may be needed.

The cause of the edema should be rapidly identified and treated. For example, if a heart attack has caused the condition, the heart must be treated and stabilized.

Water pills (diuretics), such as furosemide (Lasix) may be given to help excess water leave the body with the urine. Medications to strengthen the heart muscle, control its rhythm, or to relieve the pressure on the heart may also be given.

Although pulmonary edema is a life-threatening condition, it can be treated. How well a patient does depends on what is causing the edema and what treatment is given.

Some patients may need to use a breathing machine for a long time. If not treated, this condition can be fatal.

Go to the emergency room or call 911 if you have breathing problems.

If you have a disease that can lead to pulmonary edema, you should be sure to take all medicines as instructed. Following a healthy diet, one usually low in salt, can significantly decrease your risk of this condition.

Hess OM, Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 23.

American College of Cardiology/American Heart Association. ACC/AHA Task Force on Practice Guidelines. Update to the 2001 Guidelines for the Evaluation and Management of Heart Failure. J Am Coll Cardiol. 2005;46(6):e1-82.