Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
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.
Edema, in general, means swelling. This typically occurs
when fluid from inside blood vessels seeps outside the blood vessel into the surrounding
tissues, causing swelling. This can happen either because of too much pressure
in the blood vessels or not enough proteins in the bloodstream to hold on to the
fluid in the plasma (the part of the blood that does not contain any blood
cells).
Pulmonary edema is the term used when edema happens in the lungs. The
immediate area outside of the small blood vessels in the lungs is occupied by
very tiny air sacs called the alveoli. This is where oxygen from the air is
picked up by the blood passing by, and carbon dioxide in the blood is passed
into the alveoli to be exhaled out. Alveoli normally have a thin wall that
allows for this air exchange, and fluids are usually kept out of the alveoli
unless these walls lose their integrity.
Picture of the alveoli and lung
Pulmonary edema occurs when the alveoli fill up with
excess fluid seeped out of the blood vessels in the lung instead of air. This
can cause problems with the exchange of gas (oxygen and carbon dioxide),
resulting in breathing difficulty and poor oxygenation of blood. Sometimes, this can be referred to as
"water in the lungs" when describing the condition to patients.
Pulmonary edema can be caused by many different factors.
It can be related to heart failure, called cardiogenic pulmonary edema, or related to other causes,
referred to as non-cardiogenic pulmonary edema.
What causes pulmonary edema?
As mentioned earlier, pulmonary edema can be broadly divided into cardiogenic
and non-cardiogenic causes. Some of the common causes are listed below.
Cardiogenic causes of pulmonary edema
Cardiogenic causes of pulmonary edema results from high
pressure in the blood vessels of the lung due to poor heart function.
Congestive
heart failure due to
poor heart pumping function (arising from various causes such as arrhythmias and
diseases or weakness of the heart muscle),
heart
attacks, or abnormal heart
valves can lead to accumulation of more than the usual amount of blood in the
blood vessels of the lungs. This can, in turn, cause the fluid from the blood
vessels to be pushed out to the alveoli as the pressure builds up.
Non-cardiogenic pulmonary edema
Non-cardiogenic pulmonary edema can be commonly caused by the following:
Acute respiratory distress
syndrome (ARDS), a potentially serious condition
caused by severe infections, trauma, lung injury, inhalation of toxins, lung
infections, cocaine smoking, or
radiation to the lungs. In ARDS, the integrity
of the alveoli become compromised as a result of underlying inflammatory
response, and this leads to leaky alveoli that can fill up with fluid from the
blood vessels.
Kidney failure and inability to excrete fluid from the
body can cause fluid build-up in the blood vessels, resulting in pulmonary
edema. In people with advanced kidney disease,
dialysis may be necessary to remove the excess body
fluid.
High altitude pulmonary edema, which can happen due to rapid ascent to high
altitudes of more than 10,000 feet.
Brain trauma, bleeding in the brain (intracranial
hemorrhage), severe seizures, or brain surgery can sometimes result in fluid
accumulation in the lungs, causing neurogenic pulmonary edema.
A rapidly expanding lung can sometimes cause
re-expansion pulmonary edema. This may happen in cases when the lung collapses
(pneumothorax) or a large amount of fluid around the lung (pleural effusion) is
removed, resulting in rapid expansion of the lung. This can result in pulmonary
edema on the affected side only (unilateral pulmonary edema).
Rarely, an overdose on heroin or
methadone can lead to pulmonary edema.
Aspirin overdose or
chronic high dose use of aspirin can lead to aspirin
intoxication, especially in the elderly, which may cause pulmonary edema.
Other more rare causes of non-cardiogenic pulmonary
edema may include pulmonary embolism (blood clot which has traveled to the
lungs), transfusion-related acute lung injury (TRALI), some viral infections, or
eclampsia in pregnant women.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
An arrhythmia is an abnormal heart rhythm. With an arrhythmia, the heartbeats may be irregular or too slow (bradycardia), to rapid (tachycardia), or too early. When a single heartbeat occurs earlier than normal, it is called a prmature contraction.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Heart valve disease occurs when the heart valves do not work the way they should. Symptoms of valve disease include shortness of breath, weakness or dizziness, discomfort in your chest, palpitations, swelling of your ankles, feet or abdomen, and rapid weight gain.
Pulmonary hypertension is an abnormal elevation of the pressure in the pulmonary circulation caused by the constriction of the blood vessels that supply blood to the lungs. Shortness of breath and dizziness are symptoms of pulmonary hypertension. Treatment involves diuretics, blood thinners, calcium channel blockers, and using supplemental oxygen to increase blood oxygen levels.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. Causes of ARDS include: pneumonia, aspiration, severe blow to the chest, sepsis, severe injury with shock, drug overdose, and/or inflamed pancreas. Treatment for ARDS include extra oxygen, and/or medication.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.
Head injuries are one of the most common causes of death
and disability in the United States. Every year, almost a quarter million people
are hospitalized because of traumatic injuries to the brain, and 50,000 people die. As well,
80-90,000 people sustain long-term or lifelong disabilities because of a brain
injury each year. Children are not excluded, with more than 2,500 deaths and
almost a half million emergency department visits per year for head injuries.
Blows to the head most often cause brain injury, it is
important to remember that the face and jaw are located in the front of the head. Brain injury may
also be associated with injuries to these structures. It is also important to
note that a head injury does not always mean that there is also a brain injury.
The brain is a rather soft, pliable material almost jelly-like in feel, and
is surrounded by a thin layer of cerebrospinal fluid
(CSF). The brain is ...