What causes pulmonary edema. Why does swelling occur

- is one of the most dangerous states person. To understand its essence, it is worth saying a few words about the lungs themselves. They are a complex of tubes similar to an extensive network. Some tubes are hollow, others seem to be immersed in the fabric. This also includes vessels, connective fibers, intercellular fluid. Collectively, this is called interstitium. So, during pulmonary edema, the fluid content, which is contained directly in the interstitium, exceeds the norm.

Extravascular fluid tends to accumulate in the lungs, which can even lead to death. That is why, at the first signs of edema, measures should be taken, because if the edema is lightning fast, then death will occur within a couple of minutes. There is also acute edema, which is characterized by a two- or three-hour development. And also protracted - it can last from several hours to several days.

Causes

Almost always, the causes of pulmonary edema are either pathology or an unbearable load on the heart (in this case, edema is called cardiogenic). Because of this, stagnation forms in the pulmonary circulation, the vessels of the lungs begin to collapse. Diseases such as diastolic and systolic dysfunction (the so-called types of heart failure) or left ventricular dysfunction are capable of provoking edema. The cause of toxic edema is damage to the alveolo-capillary membranes by the corresponding substances (for example, alcohol or arsenic). Any products allergic may cause allergic edema.

In addition, edema can be caused by heart disease, myocardial infarction - in a word, diseases associated with the cardiovascular system; tuberculosis, chronic bronchitis, pneumonia - lung diseases; flu, acute laryngitis, measles - diseases that are characterized by intoxication; as well as poisoning frequent heartburn, uncontrolled reception drugs and even getting into the lungs of water, for example, while swimming.

Symptoms

Signs of pulmonary edema can be different and they also develop in different ways, it depends on whether the person has edema - prolonged or rapid. If the edema develops slowly, then shortness of breath appears first. Moreover, there are no reasons for this - rapid breathing torments during exertion, and even in a state of long rest. Often dizziness begins to disturb, and if at first it was fleeting attacks, then over time they become more frequent and longer. And then comes drowsiness, fatigue, a person feels overwhelmed. These are the first symptoms of pulmonary edema and should not be ignored.

Rapid edema is characterized by its rapid development, more often it happens at night. The person wakes up suddenly because it starts to feel like they are being suffocated. Puffing, then convulsive cough, worse from excitement. Sputum begins to be expectorated, which gradually becomes more liquid. Rattling or even whistling may be heard from the chest. The face usually turns pale, partly due to panic. The attack continues for 25 minutes. With such symptoms of pulmonary edema, help is needed immediately.

Diagnostics

Usually, the first alarm bells can be identified using x-rays. chest. If there is no threat, then the lungs of a person will have a normal appearance (dark areas). If there is any risk, then in the picture it will be possible to observe bright fields, atypical for healthy lungs. If the doctor saw clouding, then a deeper diagnosis of pulmonary edema is needed. Should be observed in the clinic - perhaps pulmonary alveoli filled with liquid. In these cases, the additional tests or even pressure measurement in pulmonary vessels. The latter process, although not very pleasant - a tube is inserted into visible veins in the neck - however, it allows you to accurately identify the causes of edema.

First aid

Everyone should be able to provide first aid for pulmonary edema. Since the attack usually begins when the patient is lying down, the first step is to help him take a semi-sitting position. A nitroglycerin tablet is placed under the tongue, it needs to be sucked. If it doesn’t help, then you can give a second one, but not earlier than after 10 minutes (only a day - no more than six tablets). In a word, the first step is to get rid of suffocation.

If the pressure is increased, then upper part hips, you can apply a tourniquet (after 20 minutes they must be removed!). This is necessary in order to reduce blood flow to the right side of the heart and, in the end, to prevent a pressure surge in the pulmonary circulation, which can occur in the future. Inhalation with alcohol vapors will also help: for children, use thirty percent alcohol, for adults - seventy.

Treatment

After the patient is taken to the hospital (often this is the department intensive care) emergency care comes in the form of bloodletting, the introduction of diuretics, the use of an oxygen mask. Usually, after such measures, the condition stabilizes and begins complete treatment pulmonary edema. Now you need to eliminate not the symptoms, but the very cause of the edema. Doctors constantly monitor breathing, pulse, pressure. But first of all, the nature of the edema is determined. If it is cardiogenic, then drugs are prescribed that eliminate heart failure. In cases where this is not enough, diuretics may be prescribed.

If pulmonary edema is caused by any infection, then the patient will have to undergo antibacterial and antiviral therapy. Anti-anxiety medications are often prescribed. They are essential for successful stress management. This is not only a plus for the state of mind, but also a benefit for the physical - vascular spasms are reduced, shortness of breath decreases, the penetration of tissue fluid through the capillary-alveolar membrane returns to normal.

It is important to start treatment on time, because due to the slightest delay, oxygen starvation, including starvation of the brain - a vital organ.

Pulmonary edema is considered especially severe. There is various ways solutions to this problem, but a large number of doctors advise resorting to traditional medicine with pulmonary edema.

Causes and symptoms

In general, such a state is not considered independent disease. It most likely accompanies other pathological processes in the body. It is as a result of such changes that hypoxia occurs. Clinically, it can manifest itself in the form of cyanosis and suffocation.

The causes of this condition may be:

diseases that are accompanied by a decrease in protein in the blood;
diseases in which infection enters the bloodstream;
thromboembolism pulmonary artery;
cardiovascular diseases which are characterized by stagnation of blood;
intravenous infusions of large volumes of fluids;
overdose of some medical preparations;
poisoning with toxic substances;
poisons;
lung diseases.

Basically, the symptoms appear quite abruptly and develop very quickly. The main signs of pulmonary edema are:

pressing, squeezing pain in the chest caused by a lack of oxygen;
shortness of breath at rest, rapid breathing;
sharp feeling lack of air;
heart palpitations;
frequent coughing;
jumps in blood pressure;
secretion of frothy pink sputum when coughing;
profuse sweat, blue or pale skin;
confusion, agitation, fear of death, complete loss of consciousness, and subsequently coma.

How to relieve pulmonary edema at home

Traditional medicine is rich in various recipes. They will help to stop the attack and relieve symptoms. It must be remembered that compliance with the prescription and dosage must be very clear. There are some effective folk ways, how to treat pulmonary edema folk remedies Houses.

Cherry

A decoction of cherry stalks will help alleviate the condition. To prepare the remedy, take:

1 tablespoon of cherry stalks,
a glass of boiling water.

Pour the stalks with boiling water and boil for a few minutes. Then let cool. Take 3 times a day for 1/3 cup. Duration - 1-2 months.

Linen

Help with puffiness and flax seeds. To prepare the remedy you need:

1 liter of water
4 teaspoons of flax seeds.

Pour the seeds with water and boil for 5 minutes. Remove the container from the heat and wrap in a blanket. Let it brew for several hours. Then strain and add lemon juice to taste. Drink half a glass 5-6 times a day. The intervals between doses are 2-3 hours. Duration of admission - a month. But the first results will be noticeable after the first second week.

Herbs

Take in equal proportions:

liquorice root,
juniper fruit,
lovage root,
harrow root,
glass of water.

Mix all herbs and pour cold water. Let stand for 6 hours. Then bring to a boil and simmer for another 15 minutes. Strain. Take a quarter cup four times a day.

Can you make another one medical fee. For this you need:

hypericum grass,
dog-rose fruit,
nettle leaves,
plantain leaves,
bearberry leaf,
600 ml of water.

Take all the herbs equally. Grind them and pour a tablespoon of the mixture with water. Boil 5 minutes. Then let stand for about an hour and strain. Drink the amount received per day in 3-4 doses.

They note the effectiveness of the application and such a collection:

licorice root - 30 g,
cornflower flowers - 30 g,
bearberry leaves - 40 g,
glass of water.

Mix everything and separate a tablespoon. Pour a glass of boiling water and leave for about a quarter of an hour. Take one tablespoon three times a day.

At treatment of pulmonary edema with folk remedies it is necessary to observe the reaction of your body to the reception of decoctions. It is necessary to consult a doctor before starting therapy.

How to treat pulmonary edema

There are several types of pulmonary edema, depending on the severity, form of the disease. The most famous are toxic, allergic, cardiogenic, protracted and others. Only after examining the symptoms can the treatment process begin.

Pulmonary edema is a pathology in the body in which there is leakage of fluid into the lung tissue and aveoli from blood vessels. As a rule, with a disease, gas exchange in the affected organ is disturbed, and significant changes begin. Pulmonary edema can be an independent disease and a consequence of another disease (for example, myocardial infarction, mitral stenosis, hypertension, and others).

Most common causes appearance of pulmonary edema are kidney failure, brain injury, hemorrhage, overdose of certain drugs (aspirin, methadone, heroin), some infections viral origin, eclampsia of pregnant women and others.

To start proper treatment, it is necessary to examine the body, since the disease has pronounced symptoms. First of all, shortness of breath appears at rest, which gradually increases with physical activity. Also pulmonary edema accompanied pressing sensation in the chest area and shortness of breath. For this reason, dizziness and weakness in the limbs often appear, so it is necessary to provide the patient with rest.

Pulmonary edema can be determined by appearance sick person. The skin becomes paler than usual, moisture appears on the surface. On the initial stage dry wheezing appears, which is a sign of fluid accumulation in the affected organ.

The next stage of the disease is accompanied by a sharp increase in an attack of shortness of breath, which sharply develops into suffocation. Also bright signs alveolar edema there may be a blue tongue, darkening of the skin. Nervous system the patient is very agitated, he is seized by a feeling of fear of the possibility lethal outcome etc.

Of course, in no case should you treat pulmonary edema in children on your own, as this is fraught with negative consequences. Before the arrival of doctors, it is necessary to provide the patient with a comfortable position, to protect him from heavy physical exertion. If possible, provide the patient with oxygen (through a mask or a special nasal catheter). After that, a special solution should be administered intravenously. To do this, you need to mix glucose (250 ml), vitamin C (10 ml), strophanthin (1 ml), insulin (14 units), diphenhydramine (4 ml), furosemide (40 ml) and ensure that the drug enters the body of a sick person slowly.

It should be noted that the disease can occur not only in humans. Pulmonary edema in a dog is a fairly common pathology that requires mandatory treatment. As a rule, it is first necessary to determine the stage of the disease, since the severe stage requires one complex, the initial one requires another. General recommendations are taking oral or intravenous drugs that improve the outflow of fluid from the affected organ (diuretics). With sepsis, it is advisable to take a course of antibiotics, which help restore lung function and eliminate the cause of the disease. In severe and pronounced hypoxia, specialists use artificial ventilation, due to which it is normalized respiratory process person.

To prevent pulmonary edema, it is necessary to healthy lifestyle life, which is a good prevention of many diseases. It is also advisable to avoid overdose medicines, heavy physical exertion, etc.

How to treat pulmonary edema

Our lungs are the organ that brings oxygen into and out of the body. carbon dioxide(the so-called external respiration). This is possible only with a certain structure and normal operation lungs. AT healthy condition they have pores through which air enters when inhaled. Sometimes these very pores are filled with liquid, which does not allow air to fill them. enough oxygen. Cells do not fully function.

Symptoms and consequences of pulmonary edema

With pulmonary edema, a person has difficulty breathing, then shortness of breath is not just brisk walking or physical exertion, but constantly, with any movements and even at rest. If you have a stethoscope at home, then after listening to the lungs, you will hear gurgling and wheezing. The more pronounced shortness of breath you have, the more complicated the form of edema. Plus, the lack of oxygen causes dizziness and general weakness. In rare cases, suffocation occurs.

Causes of pulmonary edema disease

There are two factors here:

Pulmonary edema due to problems with the cardiovascular system. Congenital or acquired diseases can lead to poor circulation and increased blood pressure in the vessels. Blood stagnates in the lungs, part of the plasma passes through the walls of blood vessels into the lung cavity.
Diseases internal organs. Kidney problems (no filtration occurs, blood has a lot of fluid and it accumulates in the lungs), brain injury (damage to the part of the brain that is responsible for the functioning of the glands internal secretion controlling the water-salt balance)
An overdose of narcotic drugs (heroin, cocaine) and an individual allergy to certain medications (up to aspirin!)
A blood clot in a pulmonary vein or artery (it interferes with blood circulation and blood stasis in the lungs)

How to treat pulmonary edema

Treatment of pulmonary edema is carried out exclusively on an outpatient basis. In the initial stage of the disease, diuretics are prescribed to remove excess fluid plus heart drugs (if the disease is caused by heart problems).

If the edema progresses, then diuretics are administered intravenously. In other cases, the problem that leads to swelling is eliminated. If the patient's condition worsens, artificial ventilation of the lungs is prescribed. If pulmonary spasm occurs suddenly, then a tracheotomy is performed.

Acute pulmonary edema is a violation of blood and lymph circulation, which causes an active exit of fluid from the capillaries into the tissue of the named organ, which ultimately provokes a violation of gas exchange and leads to hypoxia. Acute edema increases rapidly (the duration of the attack is from half an hour to three hours), which is why even with timely started resuscitation it is not always possible to avoid death.

How does acute pulmonary edema develop?

Acute pulmonary edema - the cause of death of many patients - develops as a result of infiltration into the lung tissue, where it is collected in such an amount that the possibilities for air passage are greatly reduced.

Initially, the named edema has the same character as the edema of other organs. But the structures that surround the capillaries are very thin, because of which the liquid immediately begins to enter the cavity of the alveoli. By the way, it also appears in the pleural cavities, however, to a much lesser extent.

Diseases that may cause acute pulmonary edema

Acute pulmonary edema is the cause of death in the course of many diseases, although in some cases it can still be stopped with the help of medications.

Pathologies that can provoke pulmonary edema include pathologies of cardio-vascular system, including damage to the heart muscle with hypertension, birth defects and congestion in the systemic circulation.

No less common causes of pulmonary edema are severe skull injuries of various etiologies, as well as meningitis, encephalitis and various brain tumors.

It is natural to assume the cause of pulmonary edema in diseases or lesions such as pneumonia, inhalation toxic substances, chest trauma, allergic reactions.

Surgical pathologies, poisoning, and burns can also lead to the edema described.

Types of pulmonary edema

In patients, two main, radically different types of pulmonary edema are most often observed:

cardiogenic ( cardiac edema lungs), caused by stagnation of blood in the lungs;
non-cardiogenic, caused by increased permeability, acute damage to the named organ, or acute respiratory distress syndrome;
toxic edema related to the non-cardiogenic type is considered separately.

However, despite the fact that their causes are different, these edema can be very difficult to differentiate due to similar clinical manifestations attack.

Pulmonary edema: symptoms

Emergency care provided for pulmonary edema on time still gives the patient a chance to survive. To do this, it is important to know all the symptoms of this pathology. They appear quite brightly and are easily diagnosed.

At the beginning of the development of an attack, the patient often coughs, his hoarseness increases, and his face, nail plates and mucous membranes become cyanotic.
Suffocation increases, accompanied by a feeling of tightness in the chest and pressing pain. For relief, the patient is forced to sit down and sometimes lean forward.
The main signs of pulmonary edema also appear very quickly: rapid breathing, which becomes hoarse and bubbling, weakness and dizziness appear. The veins in the neck swell.
Coughing produces pink, foamy sputum. And when the condition worsens, it can stand out from the nose. The patient is frightened, his mind may be confused. The limbs, and then the whole body, become wet with cold clammy sweat.
The pulse quickens to 200 beats per minute.

Features of toxic pulmonary edema

A slightly different picture is toxic pulmonary edema. It is caused by poisoning with barbiturates, alcohol, and the penetration of poisons into the body, heavy metals or nitric oxides. Burn lung tissue, uremia, diabetic, can also provoke the described syndrome. Therefore, any severe choking attack that occurs in these situations should lead to suspicion of pulmonary edema. Diagnosis in these cases must be thorough and competent.

Toxic edema quite often occurs without characteristic symptoms. For example, with uremia, very scarce external signs in the form of chest pain, dry cough and tachycardia do not correspond to the picture seen with x-ray examination. The same situation is typical for toxic pneumonia, and in case of poisoning with metal carbonites. And poisoning with nitrogen oxides can be accompanied by all the signs of edema described above.

First non-drug aid for pulmonary edema

If the patient has symptoms accompanying pulmonary edema, emergency care should be provided to him even before admission to the hospital. intensive care unit. Necessary activities conducted by an ambulance on the way to the hospital.

Medical care for pulmonary edema

The variety of manifestations that accompany an attack has led to the fact that many drugs are used in medicine that can relieve acute pulmonary edema. The cause of death in this case can lie not only in the pathological condition itself, but also in the wrong treatment.

Morphine is one of the drugs used to treat swelling. It is especially effective if the attack was caused by hypertension, mitral stenosis or uremia. Morphine reduces shortness of breath by depressing the respiratory center, relieves tension and anxiety in patients. But at the same time he is able to increase intracranial pressure, why the application it in patients with disorders cerebral circulation should be very careful.

To reduce hydrostatic intravascular pressure in pulmonary edema, Lasix or Furosemide are used intravenously. And to improve pulmonary blood flow, heparin therapy is used. Heparin is administered as a bolus (bolus) at a dose of up to 10,000 IU intravenously.

Cardiogenic edema, in addition, requires the use of cardiac glycosides ("Nitroglycerin"), and non-cardiogenic - glucocorticoids.

Severe pain is relieved with the help of drugs "Fentanyl" and "Droperidol". If it is possible to stop the attack, therapy of the underlying disease begins.

Pulmonary edema: consequences

Even if the relief of pulmonary edema was successful, the treatment does not end there. After such an extremely difficult condition for the whole organism, patients often develop serious complications, most often in the form of pneumonia, which in this case is very difficult to treat.

Oxygen starvation affects almost all organs of the victim. The most serious consequences of this may be cerebrovascular accident, heart failure, cardiosclerosis and ischemic lesions organs. These conditions can not do without constant and enhanced medical support, they, despite the stopped acute pulmonary edema, are the cause of death. a large number sick.

Most often, such a reaction is observed in diseases of the heart and blood vessels, approaching in these cases in its essence and clinical manifestations with the syndrome of cardiac asthma. Pulmonary edema, along with the already noted pathogenetic factors, is also caused by other mechanisms: increased permeability of the pulmonary capillaries and changes in the composition of the blood plasma. First aid is very important for a sudden onset of the disease, so we will consider this issue in detail.

Symptoms of the development of pulmonary edema

Pulmonary edema develops suddenly - at night, during sleep, with the patient waking up in a state of suffocation or during the day with physical effort or excitement. In many cases, there are harbingers of an attack in the form of frequent coughing, an increase in moist rales in the lungs. With the onset of an attack, the patient takes vertical position, the face expresses fear and confusion, acquires a pale gray or gray-cyanotic hue. With a hypertensive crisis and acute cerebrovascular accident, it can be sharply hyperemic, and with a heart defect, it can have a characteristic "mitral" (cyanotic blush on the cheeks) appearance.

A patient with symptoms of pulmonary edema feels excruciating suffocation, which is often accompanied by tightness or pressing pain in the chest.

Breathing is sharply accelerated, bubbling wheezing is heard at a distance, the cough becomes more frequent, accompanied by the release of a large amount of light or pink foamy sputum.

In severe cases of pulmonary edema, foam flows from the mouth and nose.

A patient with edema is not able to determine what is more difficult for him - inhalation or exhalation; due to shortness of breath and cough, he is unable to speak.

Cyanosis increases, the neck veins swell, the skin becomes covered with cold, sticky sweat.

Morphological signs of pulmonary edema

The result of pulmonary edema is increased vascular permeability and extravasation of the liquid part of the blood into the lumen of the alveoli. The protein-rich transudate foams vigorously when it comes into contact with air, as a result of which its volume increases sharply during pulmonary edema, the respiratory surface of the lungs is significantly reduced and there is a threat of asphyxia. The volume of foam in this case can be 10-15 times higher than the amount of transudate and reach 2-3 liters. It is released through the top Airways in the form of bloody frothy sputum.

In heart disease, an increase in pulmonary capillary permeability is a minor factor in the pathogenesis of pulmonary edema, but in other pathological conditions, such as pneumonia or phosgene poisoning, this factor can become decisive. Decreased levels of plasma proteins important role in the occurrence of pulmonary edema with nephritis.

Diagnosis of pulmonary edema

When listening to the lungs at the beginning of an attack, when edema phenomena in the interstitial (interstitial) tissue may prevail, the symptoms may be poor:

only a small number of small bubbling and single large bubbling rales are determined.
In the midst of an attack, copious wet rales of various sizes are heard over various sites lungs.
Breathing over these areas is weakened, the percussion sound is shortened.
Areas of shortened percussion sound may alternate with areas of box sound (atelectasis of some lung segments and acute emphysema of others).

X-ray examination during edema reveals expanded roots of the lungs, large focal shadows with blurred contours against the background of reduced transparency of the lung fields; effusion may be seen pleural cavity.

Pronounced changes with pulmonary edema are found in the study of the cardiovascular system. The pulse is usually sharply accelerated, often up to 140-150 beats per minute. At the beginning of the attack, it is of satisfactory filling, rhythmic (of course, if the patient had no violations before the attack). heart rate). In more rare and, as a rule, very severe cases, there is a sharp bradycardia. Inspection, palpation, percussion and listening reveal symptoms that depend not so much on the attack itself, but on the disease against which pulmonary edema developed. As a rule, the borders of dullness of the heart are expanded to the left, the tones are muffled, often not heard at all due to noisy breathing and profuse wheezing. Blood pressure depends on the initial level, which can be normal, high or low.

At long course pulmonary edema, blood pressure usually falls, the filling of the pulse weakens, it is difficult to feel it. Breathing becomes shallow, less frequent, the patient takes horizontal position he doesn't have the strength to cough up phlegm. Death due to pulmonary edema occurs from asphyxia. Sometimes the whole attack, ending in the death of the patient, lasts several minutes (lightning form). But most often it lasts for several hours and stops only after vigorous therapeutic measures. It is very important not to forget about the possibility of an undulating course of pulmonary edema, when a patient, taken out of an attack and left without proper supervision, develops a repeated severe attack, often ending in death.

The attack of suffocation, accompanied by bubbling breathing, the release of foamy liquid sputum, abundant moist rales in the lungs, is so characteristic that in these cases the diagnosis of pulmonary edema is not difficult. X-ray symptoms of the disease are an expansion of the mediastinal shadow, a decrease in the transparency of the lung fields, an expansion of the roots of the lungs, Kerley lines (a sign of edema of the interlobular septa - horizontal parallel strips 0.3-0.5 cm long near the external sinuses or along the interlobar pleura), pleural effusion. However, even without an X-ray examination, an asthma attack in bronchial asthma, accompanied by wheezing against the background of a sharply elongated exhalation, scanty viscous sputum, is difficult to confuse with pulmonary edema.

Differential symptoms of pulmonary edema

In some cases, it is not so easy to distinguish between pulmonary edema and cardiac asthma. With the latter, there is no abundant foamy sputum and bubbling breathing, moist rales are heard mainly in lower sections lungs. However, it should be borne in mind that pulmonary edema does not always occur with all the indicated characteristic symptoms: sputum is not always liquid and foamy, sometimes the patient secretes only 2-3 spittles of colorless, pink or even yellowish mucous sputum. The number of wet rales in the lungs may be small, but usually bubbling rales are heard at a distance.

There are also attacks of suffocation, not accompanied by either bubbling breathing, or moist rales in the lungs, or sputum production, but with an x-ray picture of pulmonary edema. This may depend on the predominant accumulation of fluid in the interstitial tissue, and not in the alveoli. In other cases, when serious condition sick absence common signs pulmonary edema may be due to blockage of the bronchi by sputum. Any severe attack of suffocation in a patient suffering from heart or kidney disease should cause medical worker think about the possibility of pulmonary edema.

Symptoms of toxic pulmonary edema

Much less common is toxic pulmonary edema, which may be the result of poisoning:

military poisons,
pesticides,
barbiturates,
alcohol
as well as occupational poisoning with gasoline vapors, nitrogen oxides, metal carbonyls (compounds of carbon monoxide with iron, nickel, etc.),
arsenic
or the result of uremia,
hepatic or diabetic coma,
burn.

In these cases clinical picture consists of characteristic symptoms of pulmonary edema or pathological process(upper respiratory tract infection, coma, burn disease etc.) and symptoms of pulmonary edema itself.

It should be borne in mind that toxic pulmonary edema more often than cardiac edema occurs without typical clinical manifestations. So, with uremia, toxic pulmonary edema is often characterized by a discrepancy between the meager data of a physical examination (there may be no bubbling breathing, severe cyanosis, abundant moist rales in the lungs) and pronounced typical signs of edema on x-ray examination.

Poverty clinical symptoms swelling of the lungs (only dry cough, chest pain, tachycardia are noted) against the background of severe general condition the patient is typical for toxic pneumonia, and for pulmonary edema in case of poisoning with metal carbonyls. Radiologically, in these cases, a characteristic pattern of large-focal, confluent, with blurry outlines of shadows is found in these cases with diffuse clouding of the lung fields. At the same time, for example, in case of poisoning with nitrogen oxides, there may be a detailed clinical picture of an attack with suffocation, cyanosis, noisy breathing, lemon-yellow, and sometimes pink foamy sputum, a change in areas of dullness and a boxed sound during percussion, abundant wet rales of various sizes when listening lungs, tachycardia, decreased blood pressure, muffled heart sounds.

Symptoms of complications of pulmonary edema

In many patients, long-term heart disease leads to prolonged circulatory failure; however, a significant increase in right ventricular heart failure and the severity of the patient's condition at the time of treatment require the patient to emergency care. Usually in these cases, chronic heart failure is due to rheumatic heart disease, postinfarction cardiosclerosis, or there is cor pulmonale at chronic bronchitis, pneumosclerosis, emphysema (sometimes - against the background of severe obesity). The reason for a significant deterioration in the condition with a rapid increase in the phenomena of cardiac, mainly right ventricular, insufficiency is the exacerbation of the rheumatic process with heart defects, the development of repeated infarcts of the heart muscle in patients with ischemic disease heart and cardiosclerosis, accession of pneumonia.

Draws attention on examination characteristic appearance a heart patient in a state of severe decompensation, who takes a forced exalted position. Eye-catching signs chronic insufficiency circulation, cyanosis, shortness of breath, edema; dropsy of cavities, enlargement of the liver are often noted. Examination of the heart reveals a gross pathology in the form of a defect, cardiosclerosis, often complicated atrial fibrillation with a large pulse deficit.

Acute deficiency of the right ventricle of the heart occurs when it is suddenly overloaded due to a significant increase in pressure in the vessels of the pulmonary circulation, for example, with thromboembolism of the branches of the pulmonary artery, a protracted attack bronchial asthma with the development of acute emphysema. In other cases, acute weakness of the right ventricle develops as a result of inflammatory, degenerative diseases of the heart muscle or as a result of myocardial infarction of the lower (postero-inferior) localization involving the right ventricle or an isolated right ventricular infarction.

Acute failure of the right ventricle of the heart with pulmonary edema leads to rapid development congestion in the veins great circle blood circulation, slowing blood flow, increasing venous pressure. The clinical picture of acute right ventricular failure is characterized by a rapid increase in decompensation symptoms.

The patient's condition worsens
he prefers to occupy an exalted position.
Cyanosis is pronounced, especially of the mucous membranes, nose, and extremities.
Swelling and pulsation of the veins of the neck are clearly defined,
the liver increases significantly, its palpation becomes painful.
The Plesha symptom can be determined - when pressing on the liver, swelling of the jugular veins appears or increases due to the displacement of fluid into the vena cava.

Acute overflow of the liver with blood and an increase in its size lead to stretching of the hepatic capsule, which often causes complaints of constant arching pains in the right hypochondrium and epigastric region and sometimes leads to an erroneous diagnosis of cholecystitis or stomach disease. When examining the cardiovascular system, signs of dilatation and overload of the right heart are revealed (expansion of the borders of the heart to the right, tachycardia, systolic murmur over the xiphoid process and protodiastolic gallop rhythm, accent II tone on the pulmonary artery; ECG signs of overload of the right heart). A decrease in the filling pressure of the left ventricle due to right ventricular failure can lead to a drop in the minute volume of the left ventricle and the development of arterial hypotension and even shock.

First aid for pulmonary edema

With cardiac asthma and pulmonary edema, the patient must be given an elevated position - sitting, lowering his legs from the bed. At the same time, under the action of gravity, the redistribution of blood occurs, its deposition in the veins of the legs and, accordingly, the unloading of the pulmonary circulation. Inhalation of oxygen is obligatory, since any pulmonary edema causes oxygen starvation of the body. Drug treatment of pulmonary edema should be aimed at reducing the excitability of the respiratory center and unloading the pulmonary circulation.

The purpose of first aid is the introduction of Morphine, with which it is necessary to begin the treatment of an attack of cardiac asthma and pulmonary edema. In addition to a selective effect on the respiratory center, morphine reduces blood flow to the heart and stagnation in the lungs by reducing the excitability of the vasomotor centers, and has a general calming effect on the patient. Morphine is administered subcutaneously or intravenously fractionally at a dose of 1 ml of a 1% solution. Within 5-10 minutes after the injection, breathing becomes easier, the patient calms down.

With low blood pressure, instead of Morphine, 1 ml of a 2% solution of Promedol, which is weaker, is administered subcutaneously as a first aid. In case of violation of the rhythm of breathing (breathing of the Cheyne-Stokes type), depression of the respiratory center (breathing becomes superficial, less frequent, the patient takes a lower position in bed), morphine should not be administered. Caution is also required in cases where the nature of the attack is unclear (bronchial asthma is not excluded).

Treatment of pulmonary edema in a hospital

In order to reduce the phenomena of stagnation in the lungs, they resort to the introduction of diuretics. The most effective intravenous jet injection of Lasix (Furosemide). With cardiac asthma, start with 40 mg, with pulmonary edema, the dose can be increased to 200 mg. When administered intravenously, furosemide not only reduces the volume of circulating blood, but also has a venodilating effect, thereby reducing venous return to the heart. The effect develops in a few minutes and lasts 2-3 hours.

In order to deposit blood in the periphery and unload the pulmonary circulation in case of pulmonary edema, venous vasodilators - Nitroglycerin or Isosorbide dinitrate - are intravenously dripped. The initial rate of administration of drugs in the treatment of pulmonary edema is 10-15 μg / min, every 5 minutes the rate of administration is increased by 10 μg / min until hemodynamic parameters improve and signs of left ventricular failure regress or until systolic blood pressure drops to 90 mm Hg. Art. Naturally, intravenous administration vasodilators requires constant monitoring of blood pressure levels. With the initial symptoms of left ventricular failure and the impossibility of parenteral administration, it is possible sublingual reception nitroglycerin tablets every 10-20 minutes or isosorbide dinitrate every 2 hours.

In the presence of atrial tachyarrhythmia, rapid digitalization is indicated, with paroxysmal arrhythmias - electrical impulse therapy. With a pronounced emotional background, arterial hypertension the antipsychotic droperidol is used - 2 ml of a 0.25% solution is injected intravenously in a stream. With pulmonary edema against the background of arterial hypotension, intravenous drip administration of dopamine is indicated.

The indicated treatment of pulmonary edema, accompanied by oxygen therapy, often does not give a sufficient effect: this is primarily due to the formation of persistent foam in the airways, which can completely block them and lead to the death of the patient from asphyxia. A direct means of combating foaming in pulmonary edema are "foaming agents" - substances that physicochemical characteristics which provide the effect of breaking the foam. The simplest of these means is alcohol vapor: instead of water, 70% alcohol is poured into a humidifier, oxygen is passed through it from a cylinder at an initial rate of 2-3 liters, and after a few minutes at a rate of 6-7 liters of oxygen per minute. The patient breathes vapors of alcohol with oxygen coming through the nasal catheter. Sometimes cotton wool moistened with alcohol is put into the mask. Within 10-15 minutes after the patient begins to inhale alcohol vapors, bubbling breathing may disappear. In other cases, the effect occurs only after 2-3 hours of inhalation. Keep in mind the simplest, but also the least effective method: spraying alcohol in front of the patient's mouth using any pocket inhaler or regular sprayer.

Since the upper airways in pulmonary edema are often filled with mucus, foamy secretions, it is necessary to suck them out through a catheter connected to the suction. Specialized assistance includes, if necessary, such measures as intubation or tracheotomy, artificial respiration, which are used in the most severe cases. The combination of pulmonary edema and cardiogenic shock in myocardial infarction requires the use complex therapy, including funds that increase blood pressure, and analgesics.

Treatment of toxic pulmonary edema

Treatment of toxic pulmonary edema includes, in addition to cardiotropic and diuretic therapy, specific measures against the action of causative factor that caused the attack (for example, in case of poisoning with gaseous substances, the patient is first of all taken out of the danger zone). To reduce the increased permeability of the capillaries of the lungs, prednisolone or other glucocorticosteroids are administered intravenously.

All medical measures carried out taking into account the need for maximum rest for the patient. It is not transportable, since even transferring it to a stretcher can cause an increase or resumption of an attack. It is possible to transport the patient to the hospital only after stopping the attack. At the same time, it must be remembered that pulmonary edema may recur, and not leave the patient unattended, who, after the administration of narcotic analgesics and droperidol, is usually in a state of drug-induced sleep or stunning.

In the hospital at toxic edema lungs are systematically monitored and preventive therapy pulmonary edema, including protective regime, restriction of salt and liquid. If there are signs of chronic heart failure, vasodilators are used (primarily angiotensin-converting enzyme inhibitors - Captopril, Enalapril, etc.), diuretics, with tachyarrhythmia fibrillation - cardiac glycosides, if necessary - antihypertensive and antianginal therapy. When carrying out intensive diuretic therapy in order to prevent thrombosis and thromboembolic complications, subcutaneous administration of heparin is used ( usual dose- 10,000 IU 2 times a day).

Treatment of complications of pulmonary edema

Emergency care for pulmonary edema includes the use of cardiac glycosides (with tachyarrhythmia fibrillation), fast-acting diuretics (Lasix), if necessary, painkillers, antibiotics, Heparin, i.e. similar to the help for acute right ventricular heart failure. After emergency care, a patient with severe heart failure should be hospitalized in a therapeutic hospital.

Treatment of acute right ventricular failure with pulmonary edema should be carried out taking into account the nature of the underlying disease that led to decompensation. If it was caused by atrial fibrillation, the use of cardiac glycosides is necessary to slow down the rhythm and improve the contractile function of the heart. On the prehospital stage 1 ml of 0.025% Digoxin is injected intravenously by stream, digitalization is continued in a hospital. Lasix (Furosemide) acts quite quickly - parenterally and when taken orally at a dose of 40-80 mg (1-2 tablets). With a combination of right ventricular failure with arterial hypotension vasopressors (usually dopamine) are prescribed.

Naturally, cardiotonic and diuretic therapy for complications of pulmonary edema should be combined with the treatment of the underlying disease that led to right ventricular failure, for example, using

anticoagulants for thromboembolism in the pulmonary artery system,
drugs that reduce bronchospasm during an attack of bronchial asthma,
narcotic analgesics,
Heparin,
aspirin
and according to indications - thrombolysis in myocardial infarction.

A patient with acute right ventricular failure with pulmonary edema after emergency care is subject to hospitalization in a therapeutic hospital. The nature and stage of the underlying disease, complicated by acute right ventricular failure, as well as the severity of the condition of patients in most cases require transportation of patients on a stretcher.