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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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Should the patient present in respiratory distress, initial stabilization of the ABCs (airway, breathing, and circulation) may occur at the same time as, or take priority over, any diagnostic testing or examination. However, if there is time, history and physical examination are important first steps in making the diagnosis and establishing the cause of pulmonary edema.

With the history taken from the patient or family, the health care practitioner will try to determine the cause of the shortness of breath that brings the patient in for care. Symptoms of shortness of breath on exertion, chest pain, orthopnea, and paroxysmal nocturnal dyspnea (waking from sleep due to respiratory distress) may be the clue to make the diagnosis of pulmonary edema.

Past medical history may provide direction as to the cause. Patients at risk for cardiogenic pulmonary edema may have risk factors for heart disease, including high blood pressure, high cholesterol, diabetes, family history of heart disease, and smoking. Questions about signs of infection, medications and other complaints may be asked to access for reasons other than pulmonary edema that may be causing the shortness of breath.

Non-cardiogenic causes of pulmonary edema are also considered, especially in patients with no previous history of heart disease.

Physical examination often concentrates on the heart and lungs. Listening to the lungs may reveal abnormal lung sounds consistent with fluid accumulation. Wheezing may be heard, and while may people equate wheezing with asthma or chronic obstructive pulmonary disease (COPD), this is not always the case and may be due to pulmonary edema.

Listening to the heart may reveal abnormal heart sounds or murmurs associated with valvular heart disease. If right heart failure exists, there may be swelling of the feet, ankles, and legs as well as jugular venous distention (a prominence of the veins in the neck associated with fluid overload).

Often a chest X-ray is taken to assess the status of the lungs. It may reveal obvious fluid, or there may be subtle changes that give direction to the diagnosis.

An electrocardiogram (EKG) may be helpful in diagnosing heart rhythm disturbances, previous heart attack, and ventricular hypertrophy (thickening of the heart ventricle muscle) associated with hypertension.

If there is concern about the structure and pumping capabilities of the heart, an echocardiogram may be considered. This uses ultrasound images which can help identify valve abnormalities, pumping efficiency of the heart, motion of the heart wall, and heart muscle thickness. The pericardium, the lining of the heart, can also be evaluated.

Screening blood tests may be considered to look for any underlying medical issues. A complete blood count (CBC) may find an elevated white blood cell count associated with infection or stress. Blood chemistries can screen for diabetes and kidney disease. An arterial blood gas can assess lung function by assessing the oxygen and carbon dioxide levels in the blood; measuring pH and helping determine the acid-base balance of the body.

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