Monday, 25 November 2013

Pulmonary vascular disease: Pulmonary edema- The Causes

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
Pulmonary edema
Pulmonary edema is defined as a condition of fluid accumulation in the air spaces and parenchyma of the lungs of that can lead to difficult of breathing and respiratory failure.
A. Causes
1. Certain medication
There is a report of a 32-year-old primigravida with spontaneous triplet pregnancy was admitted at 33 3/7 weeks for threatened preterm labour. For tocolysis, atosiban was administered for 48 hours together with betamethasone for foetal lung maturation. One day after treatment with atosiban she developed dyspnoea caused by pulmonary oedema(4).
2. Cardiac disease and one patient with unknown cardiac issues
In case series study, there is a report of the use of intravenous atenolol, a short-acting cardioselective beta-adrenergic antagonist, to treat acute pulmonary edema in the prehospital setting. Four patients with a documented history of cardiac disease and one patient with unknown cardiac issues experienced severe respiratory distress and presented with pulmonary edema(5).
3. Giant left atrial myxoma
There is a report of a case of a huge left atrial myxoma with an unusual clinical presentation characterized by acute pulmonary edema(6). Other study report a case of a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction(7).
4. Congestive heart failureIn the study to prospectively assess the sensitivity and specificity of ultrasonographic assessment of jugular venous distension (US-JVD) for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure, showed that US-JVD is a sensitive test for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure(7a). As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. This fluid reduces normal oxygen movement through the lungs. This and the increased pressure can lead to shortness of breath(7b).
5. Kidney failure
There is a report of a17-year-old male suffered severe noncardiogenic pulmonary edema with arterial hypotension and acute renal insufficiency after withdrawal of a central venous catheter from the subclavian vein(7c).
6. Certain toxic gas
According to the study by the University of Louisville, chlorine gas is a widely used industrial compound that is highly toxic by inhalation and is considered a chemical threat agent. Inhalation of high levels of chlorine results in acute lung injury characterized by pneumonitis, pulmonary edema, and decrements in lung function(7d).
7. Acute lung injury
Pulmonary edema is an under-recognized and potentially serious complication of blood transfusion. Distinct mechanisms include adverse immune reactions and circulatory overload. The former is associated with increased pulmonary vascular permeability and is commonly referred to as transfusion-related acute lung injury (TRALI), according to the study by the Mayo Clinic College of Medicine(7e)
8. After blood transfusion
pulmonary edema frequently occurs after blood transfusion. The association between infusion of plasma and the development of suspected or possible TRALI may have important implications with regards to etiology and prevention of this syndrome, according to the study by ths Mayo Clinic College of Medicine(7f)
9. Hyperbaric oxygen therapy
There is a report of report of three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had diabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen therapy may contribute to pulmonary edema by increasing LV afterload, increasing LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, altering cardiac output between the right and left hearts, inducing bradycardia with concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity(7g).

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