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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Shortness of breath is the most common symptom of pulmonary edema and is due to the failure of the lungs to provide adequate oxygen to the body. In most cases the shortness of breath or dyspnea (dys=abnormal +pnea=breathing) has a gradual onset. However, depending on the cause, it may occur acutely. For example, flash pulmonary edema, which has an abrupt onset, is often associated with a heart attack.

The shortness of breath may initially be manifested by difficulty doing activities that once were routine. There may be a gradual decrease in exercise tolerance, where it takes less activity to bring on symptoms. In addition to shortness of breath, some patients with pulmonary edema will also wheeze.

Orthopnea and paroxysmal nocturnal dyspnea are two variants of shortness of breath seen in association with pulmonary edema.

• Orthopnea describes shortness of breath while lying flat. Some patients with orthopnea may use two or three pillows to prop themselves up at night or resort to sleeping in a recliner.
  
  
• Symptoms of paroxysmal nocturnal dyspnea are generally described by the patient as wakening in the middle of the night, short of breath, with a need to walk around and perhaps stand by a window.

The lack of oxygen in the body can cause significant distress, leading to a respiratory crisis, gasping for air, and feeling unable to breathe. In effect, if there is enough fluid in the lungs, it can feel like a drowning. The patient may begin coughing up frothy sputum, become markedly sweaty and cool and clammy. The lack of oxygen can also affect other organs. Confusion and lethargy from lack of oxygen delivery to the brain; and angina (chest pain) from the heart, can both be associated with massive pulmonary edema and respiratory failure.

Pulmonary edema is due to left heart failure, in which pressure backs up into the blood vessels of the lungs, but some patients also have associated right heart failure. In right heart failure, the pressure backs up in the veins of the body, and fluid accumulation can occur in the feet, ankles, and legs as well as any other dependent areas like the sacrum, if the patient sits for prolonged periods of time.

Patients with high altitude pulmonary edema may also develop high altitude cerebral edema (inflammation and swelling of the brain). This may be associated with headache, vomiting, and poor decision making.

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