Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association
Recognizing Pulmonary Edema: Key Warning Signs To Watch For
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Pulmonary edema is a critical condition where fluid accumulates in the lungs, causing leakage from blood vessels into air sacs normally filled with air for oxygen exchange. This accumulation impedes breathing and reduces oxygen transfer into the bloodstream.
Michael Arterburn, who goes by @killer_bee_tactical on Instagram, highlighted the dangers of pulmonary edema in a post on May 10. He referenced the tragic case of Ray Johnson, a 64-year-old from Michigan who allegedly developed the condition and died in February 2022 after snorkeling in Maui.
Although officially ruled a drowning, Johnson's lawyers argue he succumbed to rapid onset pulmonary edema—a severe variant where the lungs fill rapidly with fluid, compromising oxygen delivery and leading to hypoxia, Fox News reported.
What causes pulmonary edema?Per Healthline, pulmonary edema can manifest suddenly or develop gradually, with its presentation varying depending on the underlying cause. Congestive heart failure stands as a frequent instigator of this condition and can occur when the heart fails to effectively circulate blood, leading to elevated pressure in the lungs' small blood vessels and subsequent fluid leakage. Normally, the lungs absorb oxygen from inhaled air into the bloodstream, but when fluid accumulates, this vital exchange falters, depriving the body of essential oxygen.
Additional contributing medical conditions encompass heart attacks, valve disorders, cardiomyopathy, irregular heart rhythms, sudden hypertension, pneumonia, renal failure and severe infections like sepsis. Factors such as higher rates of certain chronic conditions like hypertension, diabetes and heart disease may increase the risk of developing conditions like pulmonary edema in Black people.
As highlighted in Arterburn's video, in the case of Johnson, investigators believe that high-altitude exposure played a role in his fatal rapid-onset pulmonary edema.High-altitude pulmonary edema (HAPE) can strike adults and children alike during high-altitude travel or within individuals who engage in vigorous exercise at great heights, Arterburn mentioned. Its symptoms resemble those of acute pulmonary edema, including headaches followed by increasing breathlessness, initially with exertion and then even at rest. Reduced stamina is noticeable, accompanied by a dry cough that may transition to a productive cough producing frothy sputum, sometimes tinged pink or streaked with blood as the condition progresses.
Johnson's legal representatives believe his death might have been avoidable if he had waited three days after flying before snorkeling, allowing his lungs to acclimate. Studies show that tourists typically endure at least five hours of flight time to reach Hawaii, where airplane cabins are pressurized to altitudes equivalent to up to 8,500 feet. This pressurization can impact lung membrane permeability, potentially increasing the risk of conditions like rapid onset pulmonary edema, Fox News noted.
Additionally, the swimmer's horizontal stance in the water coupled with the constriction of their snorkel tube imposes resistance that can hamper the flow of oxygen. Swimming itself demands considerable physical effort which can also increase risk.
If you're flying to a tropical destination this summer, it's advisable to wait a few days before participating in water activities. Be vigilant for symptoms of pulmonary edema, such as:
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Does Congestive Heart Failure Make You Cough?
One potential symptom of congestive heart failure is a cardiac cough. This may occur because of fluid building up in the lungs, and it may be a sign that the condition is worsening.
According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million Americans have heart failure. This means that their heart is not able to pump enough oxygen-rich blood to organs throughout the body.
One potential sign of congestive heart failure is a cardiac cough, which is a wet, chesty cough.
It may occur as a result of fluid buildup in the lungs. However, it can also be a side effect of medications taken to help treat heart failure.
Read on to learn more about cardiac cough and heart failure.
Coughing may be linked to heart failure. In these cases, it's often referred to as cardiac cough. However, having a cough doesn't mean you have heart failure — it's just a symptom that may be linked to the condition.
In addition to a cough, congestive heart failure can cause shallow breaths and a whistling noise. These symptoms may be worse when lying down. This can all be related to extra fluids in the lungs.
A cough that is related to heart failure often sounds wet and may be accompanied by blood-tinged mucus. On the other hand, coughs caused by medications used to treat congestive heart failure often sound dry.
Coughing may be a sign that your heart failure is getting worse. One 2017 study found that lung congestion was a primary cause of hospital admission among individuals with heart failure.
You may develop a cough with congestive heart failure because of fluid in the lungs.
When the heart is unable to pump blood effectively throughout the body, fluid retention can occur. Additionally, with heart failure, blood backs up in the arteries in the lungs, leading to fluid accumulation in the air sacs of the lungs.
This is a condition known as pulmonary edema. When this happens, the body will try to clear out the lungs by coughing.
As previously discussed, medications commonly prescribed for heart failure can also cause coughing. One example of this is angiotensin converting enzyme inhibitors (ACE inhibitors).
Treatment for congestive heart failure typically includes drugs that reduce the amount of sodium and fluid in the body. It may also include medications to slow the heart rate and relax the blood vessels.
In some cases, surgery may be needed to fix heart defects or implant a device that helps the heart pump. If other treatments have not worked, a heart transplant may be necessary.
Learn more about developing a treatment plan for congestive heart failure.
In addition to medications, a variety of lifestyle changes may be suggested to manage symptoms of congestive heart failure and keep your heart healthy. These can include:
If you think you have signs of heart failure, it's a good idea to contact your doctor. You should also notify your doctor if you have been diagnosed with heart failure and experience a worsening of symptoms, such as:
It's important to get immediate care if you are experiencing confusion, blue and grayish skin, or an inability to breathe freely.
Is coughing a sign of late stage heart failure?Cardiac coughing may be a sign that your heart failure is getting worse. However, coughing can be related to many causes. Your healthcare professional can help determine the cause of your cough.
Should I be concerned about my cough?If a cough is persistent, includes blood, or you're having difficulty breathing, you should let your doctor know. You should also notify your doctor if a cough is accompanied by other symptoms like chest pain, fever, or difficulty swallowing.
Is coughing related to congestive heart failure curable?Cardiac cough may be improved by treating the underlying heart failure. This may include medications, lifestyle changes, and even heart surgery.
If the cough is due to medication, such as an ACE inhibitor, your doctor may recommend stopping and switching to a different medication.
Coughing can be a sign of worsening congestive heart failure. A cardiac cough is often the result of fluid building up in the lungs and may include pink-tinged phlegm or blood.
If you're showing signs of congestive heart failure or your heart failure symptoms are becoming more severe, it's important to let your doctor know. They can recommend medications and lifestyle changes to reduce extra fluids in the body and treat related conditions.
Intensive Neurohormonal Blockade Enhances Decongestion, Reduces Mortality In Acute Heart Failure: STRONG-HF Analysis
USA: Early and intensive uptitration of the neurohormonal blockade was associated with more efficient and sustained decongestion for patients with acute heart failure (AHF), post hoc analysis of the STRONG-HF trial has shown.
"Intensive uptitration of the neurohormonal blockade resulted in more effective and sustained decongestion by day 90, along with a reduced risk of the primary endpoint, which includes all-cause mortality or heart failure (HF) readmission by day 180," the researchers reported in the Journal of the American College of Cardiology.
Heart failure is a leading cause of morbidity and mortality globally, characterized by fluid overload and a complex interplay of neurohormonal activation. Traditionally, treatment strategies have focused on the medications' gradual titration, including angiotensin-converting enzyme inhibitors (ACEi), beta-blockers, and mineralocorticoid receptor antagonists (MRAs).
Comprehensive uptitration of neurohormonal blockade addresses the underlying mechanisms of congestion and could provide an effective strategy for decongesting patients following acute heart failure. Jan Biegus, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland, and colleagues tested this hypothesis in the STRONG-HF (Safety, Tolerability, and Efficacy of Rapid Optimization, Helped by N-Terminal Pro–Brain Natriuretic Peptide Testing of Heart Failure Therapies) trial.
In the STRONG-HF trial, AHF patients were randomized to either the high-intensity care (HIC) group, which involved rapid uptitration of the neurohormonal blockade, or the usual care (UC) group. Successful decongestion was defined as an absence of pulmonary rales, peripheral edema, and jugular venous pressure <6 cm.
The analysis led to the following findings:
The findings showed a significantly greater decongestion at day 90 despite a significantly lower mean dose of loop diuretics at this time point in patients in the HIC arm. Successful decongestion was linked with a lower risk of heart failure hospitalization and all-cause mortality.
"This is the first evidence that intensive and comprehensive uptitration of the neurohormonal blockade—using ACE inhibitors, ARBs, ARNI, beta-blockers, and MRAs—during the early post-discharge phase in patients with acute heart failure promotes effective decongestion, potentially leading to improved outcomes," the researchers concluded.
Reference:
Biegus, J., Mebazaa, A., Davison, B., Cotter, G., Edwards, C., Čelutkienė, J., Chioncel, O., Cohen-Solal, A., Filippatos, G., Novosadova, M., Sliwa, K., Adamo, M., Arrigo, M., Lam, C. S., Ter Maaten, J. M., Deniau, B., Barros, M., Čerlinskaitė-Bajorė, K., Damasceno, A., . . . Ponikowski, P. (2024). Effects of Rapid Uptitration of Neurohormonal Blockade on Effective, Sustainable Decongestion and Outcomes in STRONG-HF. Journal of the American College of Cardiology, 84(4), 323-336. Https://doi.Org/10.1016/j.Jacc.2024.04.055
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