Pulmonary Edema - Page Five

Prevention

Pulmonary edema often isn't preventable, but these measures can help reduce your risk:
Preventing cardiovascular diseaseCardiovascular disease is the leading cause of pulmonary edema.

You can reduce your risk of many kinds of heart problems by following these suggestions:

Control your blood pressure. More than 50 million Americans have high blood pressure (hypertension), which can lead to serious conditions such as stroke, cardiovascular disease and kidney failure. Most adults should have their blood pressure checked at least once every two years. This is a noninvasive and painless procedure using an inflatable cuff that wraps around your upper arm. The test takes just a few minutes. Under new, stricter national blood pressure guidelines issued in May 2003, a resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is considered normal. If your resting blood pressure is consistently 140/90 mm Hg or higher, you have high blood pressure. A reading in between these levels places you in the prehypertensive category. In many cases, you can lower your blood pressure or maintain a healthy level by getting regular exercise, eating a diet rich in fresh fruits, vegetables and low-fat dairy products, and limiting alcohol and coffee.

Watch your blood cholesterol. Cholesterol is one of several types of fats essential to good health. But too much cholesterol can be too much of a good thing. Higher than normal cholesterol levels (hypercholesterolemia) can cause fatty deposits to form in your arteries, impeding blood flow and increasing your risk of vascular disease. But lifestyle changes can often keep your cholesterol levels low. This includes limiting fats to no more than 30 percent of your diet, eating more fiber, fish, and fresh fruits and vegetables, exercising regularly, stopping smoking, and drinking in moderation.

Don't smoke. If you smoke, the single most important thing you can do for your heart and lung health is to stop. Continuing to smoke increases your risk of a second heart attack or heart-related death and also increases your risk of lung cancer and other lung problems such as emphysema. What's more, you're at risk even if you don't smoke but live or work with someone who does. Exposure to secondhand smoke has been shown to be a contributing factor to coronary artery disease. If you can't stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit.

Eat a heart-healthy diet. Fish is one of the cornerstones of a heart-healthy diet — it contains omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. It's also important to eat plenty of fruits and vegetables, which contain antioxidants, vitamins and minerals that help prevent everyday wear and tear on your coronary arteries. Limit your intake of all types of fats to no more than 30 percent of your daily calories, and animal (saturated) and trans fats (hydrogenated oils) to 10 percent or less.

Limit salt. It's especially important to limit your salt intake if you have heart disease. In some people with impaired left ventricular function, excess salt — even in a single meal or a bag of chips —may be enough to trigger congestive heart failure. If you're having a hard time cutting back on salt, it may be helpful to talk to a dietitian. He or she can help point out low sodium foods as well as offer tips for making a low salt diet interesting and good-tasting.

Exercise regularly. Exercise is vital for a healthy heart. Regular aerobic exercise helps maintain a healthy weight, controls blood pressure and cholesterol levels, helps prevent diabetes and maintains muscle tone. Aim for at least 30 minutes of exercise on most days. If you're not used to exercise, start out slowly and build up gradually.

Maintain a healthy weight. Being even slightly overweight increases your risk of cardiovascular disease. On the other hand, losing only 5 to 10 pounds can lower your blood pressure and reduce your risk of diabetes.

Get enough folic acid (folate). An essential B vitamin, folate may reduce blood levels of homocysteine, an amino acid that builds and maintains tissues. Too much homocysteine can promote the formation of plaque in your arteries. To get 400 micrograms of folate a day, eat green, leafy vegetables, citrus fruits, legumes, peanuts and cereal grains. If you're not sure how much folate you're getting from your diet, talk to your doctor about a folic acid supplement, or choose a multivitamin supplement that contains at least 400 micrograms of folic acid.

Manage stress. To reduce your risk of heart problems, try to reduce your stress levels. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.

Preventing HAPE

If you travel or climb at high altitudes, acclimate yourself slowly. Although recommendations vary, most experts advise ascending no more than 1,000 or 2,000 feet a day once you reach 8,000 feet. In addition, it's important to drink plenty of water to stay hydrated. The higher you ascend the more rapidly you breathe, which means you lose larger amounts of water in the air you exhale from your lungs. Finally, although being physically fit won't necessarily prevent HAPE, people in good condition tend to be less stressed at high altitudes.

Self-Care

The following suggestions may speed your recovery from cardiac pulmonary edema and help prevent a recurrence:

Get at least seven hours of sleep a night. Take a nap during the day if you feel tired.

Listen to medical advice. Follow your doctor's advice about controlling any underlying health problems, including advice about diet and exercise.

Try to get at least 30 minutes of exercise on most days. If your exercise plan seems too hard or too easy, talk to your doctor or a rehabilitation therapist.

Weigh yourself in the morning before breakfast. Call your doctor if you've gained 2 to 3 pounds in a single day.

Avoid drinking alcohol. Your lungs and heart work harder when you drink alcohol.
If you've experienced noncardiac pulmonary edema — including some forms of ARDS — take care to minimize any further damage to your lungs, and as far as possible avoid the cause of your condition, such as drugs, allergens or high altitudes.

© 1998-2005 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

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Pulmonary Edema - Page Four

When To Seek Medical Advice

Acute pulmonary edema is life-threatening. Get emergency assistance if you have any of the following acute signs and symptoms:

Trouble breathing or a feeling of suffocating (dyspnea)
A bubbly, wheezing or gasping sound when you breathe
Pink, frothy sputum when you cough
Profuse sweating
Lightheadedness
A blue or gray tone to your skin
A severe drop in blood pressure

Acute pulmonary edema is likely to be incapacitating, so don't attempt to drive yourself to the hospital. Instead, dial 911 or emergency medical care and wait for help.

Screening and Diagnosis

Because pulmonary edema requires prompt treatment, you'll initially be diagnosed on the basis of your symptoms and a physical exam. You may also have blood drawn — usually from an artery in your wrist — so that it can be checked for the amount of oxygen and carbon dioxide it contains (arterial blood gas concentrations).

Once your condition is more stable, your doctor will ask about your medical history, especially whether you have ever had cardiovascular or lung disease. You will also likely have a chest X-ray, which can help support a diagnosis of pulmonary edema. And you may have further tests to determine why you developed fluid in your lungs. These tests may include:

Electrocardiography (ECG). This noninvasive test can reveal a wide range of information about your heart. During an ECG, patches attached to your skin receive electrical impulses from your heart. These are recorded in the form of waves on graph paper or a monitor. The wave patterns show your heart rate and rhythm, and whether areas of your heart show diminished blood flow.

Echocardiography (diagnostic cardiac ultrasound exam). Another noninvasive test, echocardiography uses a wand-shaped device called a transducer to generate high-frequency sound waves that are reflected from the tissues of the heart. The sound waves are then sent to a machine that uses them to compose images of your heart on a monitor. The test can help diagnose a number of heart problems, including valve problems, abnormal motions of the ventricular walls, fluid around the heart (pericardial effusion) and congenital heart defects. It also accurately measures the amount of blood your left ventricle ejects with each heartbeat (ejection fraction, or EF). The ventricles don't empty all their blood with each beat, but in most cases the EF should be greater than 50 percent. When the left ventricle begins to fail, this number falls. Although a low EF often indicates a cardiac cause for pulmonary edema, it's possible to have cardiac pulmonary edema with a normal EF.

Transesophageal echocardiography (TEE). In a traditional cardiac ultrasound exam, the transducer remains outside your body on the chest wall. But in TEE, a soft, flexible tube with a special transducer tip is inserted through your mouth and into your esophagus — the passage leading to your stomach. This provides a clearer view of your heart and central pulmonary arteries than does traditional echocardiography. You'll be given a sedative to make you more comfortable and prevent gagging. You may have a sore throat for a few days after the procedure, and there's a slight risk of perforation or bleeding from the esophagus.

Cardiac catheterization. If other tests don't reveal the reason for your pulmonary edema, your doctor may suggest a procedure to measure the pressure in your lung capillaries (wedge pressure). During this test, a small, balloon-tipped catheter is inserted through a vein in your leg or arm into a pulmonary artery. The catheter has two openings connected to pressure transducers. The balloon is inflated and then deflated, giving pressure readings.

Complications

When not treated, acute pulmonary edema can be fatal. In some instances it may be fatal even if you receive treatment. The outcome depends in part on the condition of your heart and lungs before you developed edema and on the amount of fluid in your lungs. Drug-induced pulmonary edema is a frequent cause of death in people who abuse narcotics.

Treatment

Administering oxygen is the first step in treating any kind of pulmonary edema. You usually receive oxygen through a face mask or nasal cannula — a flexible plastic tube with two openings that deliver oxygen to each nostril. This should ease some of your symptoms. Sometimes it may be necessary to assist your breathing with a machine.

Depending on your condition and the reason for your pulmonary edema, you may also receive one or more of the following medications:

Furosemide (Lasix). This diuretic works quickly to expel excess fluid from your body in cases of cardiac pulmonary edema.

Morphine (Astramorph, Roxanol). This narcotic, for years a mainstay in treating cardiac pulmonary edema, may be used to relieve shortness of breath and associated anxiety. But some doctors now believe that the risks of morphine may outweigh the benefits and are more apt to use other, more effective, drugs.

Afterloaders. These are drugs that dilate the peripheral vessels and take a pressure load off the left ventricle.

Aspirin. Your doctor may recommend starting aspirin therapy if you're not already taking it. Aspirin helps thin the blood so that it moves through your small blood vessels more easily.
Blood pressure medications. If you have high blood pressure when you develop pulmonary edema, you'll be given medications to control it. On the other hand, if your blood pressure is too low, you're likely to be given drugs to raise it.

Treating high-altitude pulmonary edema (HAPE). If you're climbing or traveling at high altitudes and experience mild symptoms of HAPE, descending a few thousand feet should relieve your symptoms. Oxygen also is helpful. When symptoms are more severe, you'll likely need help in your descent. A helicopter rescue may be necessary for the most serious cases.

Sometimes, however, immediate rescue isn't possible. With this in mind, researchers have devised several experimental therapies. In one, the distressed climber is placed in an airtight bag known as a hyperbaric bag, which is then pumped with air, simulating the air pressure at a lower altitude. A night's sleep in the bag seems to relieve symptoms — at least temporarily.

Some climbers take the prescription medication acetazolamide (Diamox) to prevent symptoms of HAPE. Diamox can occasionally have side effects — including tingling or burning in the hands, feet and mouth, confusion, diarrhea, nausea, and thirst — and must be started three days before your ascent.

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Pulmonary Edema - Page Three

Pulmonary Edema - Causes

Your lungs are two spongy, elastic organs inside your rib cage that stretch and contract as you breathe. Although your lungs can hold up to 4 quarts of air, you generally inhale only a fraction of that with each breath.

Two major airways (bronchi) carry air into your lungs. These airways subdivide into smaller airways (bronchioles) that finally end in clusters of tiny air sacs. Each lung has about 300 million air sacs, which inflate like miniature balloons every time you inhale.

Wrapped around each air sac are capillaries that connect the arteries and veins in your lungs. The capillaries are so narrow that red blood cells have to pass through them in single file. Each red blood cell absorbs oxygen, while the plasma — the fluid containing the red blood cells — releases carbon dioxide.

But in certain circumstances the alveoli fill with fluid instead of air, preventing oxygen from being absorbed into your bloodstream. A number of factors can cause fluid to accumulate in your lungs, but most have to do with your heart (cardiac pulmonary edema). Understanding the relationship between your heart and lungs can help explain why.

How your heart works

Your heart is composed of two upper and two lower chambers. The upper chambers (the right and left atria) receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves — which keep blood flowing in the correct direction — are gates at the chamber openings.

Normally, deoxygenated blood from your body enters the right atrium and flows into the right ventricle, where it's pumped through large blood vessels
(pulmonary arteries) to your lungs. There, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then returns to the left atrium through the pulmonary veins, flows through the mitral valve into the left ventricle, and finally leaves your heart through another large artery, the aorta. The aortic valve at the base of the aorta keeps the blood from flowing backward into your heart. From the aorta, the blood travels to the rest of your body.

What goes wrong

Cardiac pulmonary edema — also known as congestive heart failure — occurs when the left ventricle isn't able to pump out enough of the blood it receives from your lungs. As a result, pressure increases inside the left atrium and then in the pulmonary veins and capillaries, causing fluid to be pushed through the capillary walls into the air sacs.

Congestive heart failure can also occur when the right ventricle is unable to overcome increased pressure in the pulmonary artery, which usually results from left heart failure, chronic lung disease, or high blood pressure in the pulmonary artery (pulmonary hypertension).

Medical conditions that can cause the left ventricle to become weak and eventually fail include:

Coronary artery disease. Over time, the arteries that supply blood to your heart can become narrow from fatty deposits (plaques). A heart attack occurs when a blood clot forms in one of these narrowed arteries, blocking blood flow and damaging the portion of your heart muscle supplied by that artery. The result is that the damaged heart muscle can no longer pump as well as it should. Although the rest of the heart tries to compensate for this loss, it's either unable to do so effectively or it's weakened by the extra workload. Normally, the ventricles pump about 50 percent to 60 percent of the blood they contain with each contraction. But when the pumping action of the heart is weakened, this figure may fall as low as 15 percent. In that case, blood backs up into the lungs, forcing fluid in the blood to pass through the capillary walls into the air sacs.

Cardiomyopathy. When your heart muscle is damaged by causes other than blood flow problems, the condition is called cardiomyopathy. Often, cardiomyopathy has no known cause, although it sometimes runs in families. Less common causes include infections (myocarditis), alcohol abuse and the toxic effects of drugs such as cocaine and some types of chemotherapy. Because cardiomyopathy weakens the left ventricle — the heart's main pump — it may not be able to respond to conditions that require it to work harder, such as a surge in blood pressure or infections. When the left ventricle can't keep up with the demands placed on it, fluid backs up into the lungs.

Heart valve problems. In mitral valve disease or aortic valve disease, the valves that regulate blood flow either don't open wide enough (stenosis) or don't close completely (insufficiency). This allows blood to flow backward through the valve. When the valves are narrowed, blood can't flow freely into your heart and pressure in the left ventricle builds up, causing the left ventricle to work harder and harder with each contraction. The increased pressure extends into the left atrium and then to the pulmonary veins, causing fluid to accumulate in your lungs. On the other hand, if the mitral valve leaks, some blood is backwashed toward your lung each time your heart pumps. If the leakage develops suddenly, you may develop sudden and severe pulmonary edema.

High blood pressure (hypertension). Untreated or uncontrolled high blood pressure causes a thickening of the left ventricular muscle, and accelerates coronary artery disease.

If pulmonary edema persists, it can raise pressure in the pulmonary artery and eventually the right ventricle begins to fail. The right ventricle has a much thinner wall of muscle than does the left side. The increased pressure backs up into the right atrium and then into various parts of the body, where it can cause leg swelling (edema), abdominal swelling (ascites) or a buildup of fluid in the pleural space (pleural effusion).

Noncardiac pulmonary edemaNot all pulmonary edema is the result of heart disease. Fluid may also leak from the capillaries in the lungs' air sacs because the capillaries themselves become more permeable or leaky, even without the buildup of back pressure from the heart. In that case, the condition is known as noncardiac pulmonary edema because the heart isn't the cause of the problem.

Some factors that can cause increased capillary permeability leading to noncardiac pulmonary edema are:

Lung infections. When pulmonary edema results from lung infections, such as pneumonia, the edema occurs only in the part of the lung that's inflamed.

Exposure to certain toxins. These include toxins you inhale — such as chlorine, ammonia or nitrogen dioxide — as well as those that may circulate within your own body. For example, women giving birth may develop pulmonary edema when amniotic fluid reaches the lungs through the veins of the uterus (amniotic fluid embolism).

Severe allergic reactions (anaphylaxis). You can have serious allergic reactions to some medications as well as to certain foods and insect venom.

Smoke inhalation. Children and older adults are especially vulnerable to lung damage caused by breathing smoke from structural fires. Smoke contains chemicals that damage the membrane between the air sacs and the capillaries, allowing fluid to enter the lungs.

Drug overdose. More than 20 drugs — ranging from narcotics such as heroin to diabetes medications and aspirin — are known to cause noncardiac pulmonary edema. Aspirin-induced pulmonary edema can occur in people who take increasingly large doses of aspirin to relieve pain or other symptoms. For reasons that aren't clear, smokers who use aspirin are at greater risk.

Acute respiratory distress syndrome (ARDS). This serious disorder occurs when your lungs suddenly fill with fluid and inflammatory blood cells. Many conditions can cause ARDS, including severe injuries (trauma), systemic infection (sepsis), pneumonia or shock. ARDS sometimes develops after extensive surgery. Symptoms usually appear within 24 to 72 hours after the original illness or trauma.

High altitudes. Mountain climbers and people who live in or travel to high-altitude locations run the risk of developing high altitude pulmonary edema (HAPE). This condition — which typically occurs at elevations above 8,000 feet — can also affect hikers or skiers who start exercising at higher altitudes without first becoming acclimated. But even people who have hiked or skied at high altitudes in the past aren't immune. Although the exact mechanism isn't completely understood, HAPE seems to develop as a result of increased pressure from constriction of the pulmonary capillaries. Symptoms include headaches, insomnia, fluid retention, cough and shortness of breath. Without appropriate care, HAPE can be fatal.

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Lymphedema People

Pulmonary Edema - Page Two

Overview

Your lungs contain millions of small, elastic air sacs called alveoli. With each breath, the air sacs take in oxygen and release carbon dioxide, a waste product of metabolism. Normally, the exchange of oxygen and carbon dioxide takes place without problems. But sometimes increased pressure in the blood vessels in your lungs forces fluid into the air sacs, filling them with fluid and preventing them from absorbing oxygen — a condition called pulmonary edema.

In most cases, heart problems are the cause of pulmonary edema. But fluid can accumulate in your lungs for other reasons, including lung problems such as pneumonia, exposure to certain toxins and medications, and exercising or living at high elevations.

Acute pulmonary edema is a medical emergency and requires immediate care. Although pulmonary edema can sometimes prove fatal, the outlook is often good when you receive prompt treatment for pulmonary edema along with therapy for the underlying problem.

Signs and Symptoms

Depending on the cause, the symptoms of pulmonary edema may appear suddenly or develop slowly over weeks or months.

Signs and symptoms that come on suddenly are usually severe and may include:

Extreme shortness of breath or difficulty breathing

A feeling of suffocating or drowning

Wheezing or gasping for breath

Anxiety and restlessness

A cough that produces frothy sputum that may be tinged with blood

Excessive sweating

Pale skin

Chest pain when pulmonary edema is caused by coronary artery disease

Signs and symptoms that develop more gradually include:

Difficulty breathing when you're lying flat as opposed to sitting up

Awakening at night with a breathless feeling

Having more shortness of breath than normal when you're physically active

Significant weight gain when pulmonary edema develops as a result of congestive heart failure, a condition in which your heart pumps too little blood to meet your body's needs

If you develop any of these signs or symptoms, call 911 or emergency medical assistance right away. Pulmonary edema can be fatal if not treated.

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Lymphedema People

Pulmonary Edema - Page One

Alternative names

Lung/pulmonary congestion; Lung water

Definition

Pulmonary edema involves fluid accumulation and swelling in the lungs.
Causes, incidence, and risk factors Pulmonary edema is usually caused by heart failure that results in increased pressure in the pulmonary (lung) veins. However, problems within the lungs themselves can also result in fluid accumulation.

Pulmonary edema can be a complication of a heart attack, leaking or narrowed heart valves (mitral or aortic valves), or any disease of the heart that either results in weakening and/or stiffening of the heart muscle (cardiomyopathy). The failing heart transmits its increased pressure to the lung veins. As pressure in the lung veins rises, fluid is pushed into the air spaces (alveoli). This fluid then becomes a barrier to normal oxygen exchange, resulting in shortness of breath.

Pulmonary edema can also be caused by direct lung injury from toxins including heat and poisonous gas, severe infection, or an excess of body fluid as seen in kidney failure.

Symptoms

Shortness of breath
Difficulty breathing
Feeling of "air hunger" or "drowning"
Grunting or gurgling sounds with breathing
Wheezing
Shortness of breath with lying down, causing the patient to sleep with head propped up or using extra pillows
Cough
Anxiety
Restlessness
Excessive sweating
Pale skin Additional symptoms that may be associated with this disease:
Nasal flaring
Coughing up blood
Inability to speak from air hunger
Decrease in level of awareness

Signs and tests

During a physical exam, the provider may identify the following signs:
Rapid breathing and increased heart rate
Crackles in the lungs or abnormal heart sounds (while listening to the chest with a stethoscope)
Pale or blue skin color

Possible tests include:

Blood oxygen levels (low)

A chest x-ray may reveal fluid in or around the lung space or an enlarged heart
An ultrasound of the heart (echocardiogram) may reveal weak heart muscle, leaking or narrow heart valves, or fluid surrounding the heart

Treatment

Oxygen is given via nasal prongs or a face mask. Intubation (breathing tube placed into the windpipe) and use of a breathing machine (ventilator) may be needed.

Underlying causes must be rapidly identified and treated. For example, if a heart attack has caused the condition, the heart must be treated and stabilized.

Medications to accelerate water excretion from the body via the urine (diuretics) are given. One common diuretic is furosemide (Lasix). Other medications to strengthen the heart muscle or to relieve the pressure on the heart may also be given as needed.

Expectations (prognosis)

Although pulmonary edema can be a life-threatening condition, it is often readily treatable. Prognosis, however, depends upon the underlying disease.

Complications

The patient may require long-term dependence on a breathing machine (ventilator).

Calling your health care provider

Go to the emergency room or call 911 if conditions suggesting pulmonary edema occur, particularly if breathing is difficult.

Prevention

In patients with known diseases that can lead to pulmonary edema, strict compliance with taking medications in a timely manner and following an appropriate diet (usually, low in salt) can significantly decrease one's risk.

Update Date: 7/6/2004

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See Also

Congestive Heart Failure and Pulmonary Edema

. . . . . .

Pulmonary Edema

Congestive Heart Failure

Related terms:

Cardiomyopathy, Pulmonary Edema, CHF, Localized edema, Left Sided Heart Failure, Right Sided Heart Failure, Systolic Heart Failure, Diastolic Heart Failure, Pleural Effusions, Acute Pulmonary Edema, Lymphedema, Lymph System, Lymphatics, Electrocardiogram, Echocardiogram, Multiple-gated Acquisition Scan, MUGA, Beta Naturetic Peptide, B-type

Discussion:

This is one of the most common diseases in the United States, affecting an estimated five million people, wih an estimate 500,000 new cases as year. While there is no "cure," there is treatment not only for the condition but for the complications associated with it. Heart failure is a condition in which the heart is no longer able to efficiently pump enough blood through the body. It is a gradually worsening condition that develops usually over a period of time.

It can develop in either side of, or the entire heart. In left sided heart falure, the heart is not able to pump enough blood through the entire body, whereas in right sided heart failure, the heart cannot pump blood efficient or effectively through the lungs. Left sided heart failure is the more common of the two.

Symptoms:

The most common symptoms of heart failure are shortness of breath or difficulty in breathing, feeling tired and unexplained swelling of the ankles, feet and legs. (edema).

Fluid build up in the lungs may also cause coughing and is generally worse at night when in bed. You may even experience episodes of waking up feeling as if your are drowning and unable to breath. This can lead to the life threatening condition known as acute pulmonary edema.

The swelling in the ankles, feet and leg is not to be confused with lymphedema.

The swelling from lymphedema is caused by malformations, destruction of or damage to the lymph system (lymphatics) and is not related to congestive heart failure. It is also not a recognized causative factor in congestive heart failure. Other indications of swelling will include weight gain and more frequent urination as the body attempts to cope with the fluid build up. Edema from congestive heart failure is a result of the heart inability to pump blood and fluids back through the cardiovascular system. As the fluid "wait" to be pumped back through the heart, it builds up in the leg and begins to "leak" out of the permeable structure of the veins.

Symptoms of chronic heart failure are broken down into four classes, depending on the lmitations the conditions places on your ability to engage in various activities. (1)

Class 1: No limitations on activities. Activities do not cause undue fatigue or shortness of breath.

Class 2: Slight or mild limits. You are comfortable at rest, but are beginning to experience more tiredness and shortness of breath when undertaking normal physical activity.

Class 3: Marked or noticeable limits--comfortable at rest, but less than ordinary physical activity causes tiredness or shortness of breath.

Class 4: Severe limits--unable to carry on any physical activity without discomfort. Symptoms are also present at rest. If any physical activity is undertaken, discomfort increases.

Complications:

Blood and fluid back up in the lungs (pulmonary edema or pleural effusions); buildup of fluids in the feet, ankles and legs (localized edema); tiredness and shortness of breath, mental confusion due to the lack of oxygen rich blood in the brain.

Risk Factors and Precipitating Causes:

There are many risk factors and precipitating causes leading to congestive heart failure.

The most common are life style choices we make and as such, we can reduce our risk by maintaining proper weight, developing a healthy diet, not smoking, limiting alcohol intake, getting enough exercise and limiting caffein consumption.

Medical conditions that contribute to congestive heart failure include anemia, infections, thyrotoxicosis, endocarditis, arrhythemia, rheumatic and other forms of myocarditis, hypertension, heart attacks, pulmonary embolisms, diabetes and congenital heart disease.

Physiological Cause:

Risk factors and precipitating causes will over time affect the hearts ability to function properly. The heart simply begins to "wear" out. The body attempts to compensate by causing the heart to work harder to performs its task. The result of this is that the heart enlarges and pumps faster and less efficiently. As the heart weakens and less blood flows through the blood vessels, they narrow and constrict causing further damage. Also, as less blood becomes available, the body will begin to divert the blood supply to organs it deems most important for "survival."

Other areas begin to be deprived of the needed blood flow and this can cause atrophy of muscles.

Eventually, neither the body nor the heart is able to maintain function and the entire system begins to breakdown, leading to failure and death.

Diagnosis:

While a physical exam and patient history can help diagnose congestive heart failure, there are a number of tests that will be administered for an accurate diagnosis.

These tests may include a chest x-ray (helpful in showing pleural edema), an electrocardiogram (shows the hearts electrical activity), echocardiogram which is an ultrasound type (shows the beating of the heart), and a multiple-gated acquisition scan, MUGA (dye test which shows problems with pumping an blood flow).

Blood tests will be done that will show blood counts, sodium and potassium levels, kidney function, and will reveal the presence of a substance called beta naturetic peptide (B-type). This is a substance that is produced by a failing heart.

Treatment:

There is no cure for congestive heart failure, but there is treatment for the conditions and for the complications associated with it. A treatment program will consist of three focal points.
First is lifestyle changes. This involves (again) weight control, smoking cessation, limiting of alcohol, low fat and low cholesterol diet, proper exercise and limiting caffeine and salt.
Second, is the appropriate use of medications. Commonly used medications includes diuretics for the edema. digoxin (digitalis) to improve the pumping ability of the heart, vasodilators which helps enlarge the smaller arteries for improvement in blood flow, beta-blockers which slow down the heart rate. Other medications may include Nesiritide which is used for congestive heart failure patients in the hospital to help stabalize their condition and anti-arrhythmics which can help control the rythm of the heart

Third is the possible use of surgical therapy. This may include coronary artery bypass to improve blood flow, angioplasty to clear blockages and may in the most severe cases of congestive heart failure lead to a heart transplant. If there is arrhythemia a pacemaker may be implanted.

(c) Pat O'Connor - Lymphedema People

See Also:

Edema and Congestive Heart Failure

For Further Information:

Congestive Heart Failure

American Heart Association

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Congestive Heart Failure

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Congestive Heart Failure

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Congestive Heart Failure and Pulmonary Edema

Deep Venous Thrombosis

Deep Venous Thrombosis (DVT) & Blood Clots

Related Terms:

Blood clots, DVT, Venous Stasis, leg swelling, deep vein thrombophlebitis, pulmonary embolism, deep vein blood clots, venous thrombosis, leg edema, Homans sign, lymphedema fibrosis, sepsis, nephrotic syndrome, congestive heart failure, stroke, acute myocardial infarction, heart attack

Discussion:

Medical condition that affects mainly the lower legs and thigh and involves the formation of a blood blot. The clot cuts off blood circulation and can lead to several serious complications. The signs and symptoms of the condition will vary depending on the intensity or size of the clot.

Risk factors:

There are a number of general risk factors associated with DVT. These include age, immobilization for longer than three days, pregnancy and the post-partum period, extensive surgical procedure within the previous month, obesity.

In addition to the general risk factors, there are important medical based risk factors as well. These include cancer, sepsis, nephrotic syndrome, congestive heart failure (CHF), fibrosis in lymphedema limbs, stroke, acute myocardial infarction (AMI - heart attack).

Other causes include trauma injury, inherited hematologic disordes, and drugs and medications such as oral contraceptives and hormone replacement therapy.

Complications:

Edema of the affected limb, pulmonary embolism, post-phlebitic syndrome, hemorhagic complications from anticoagulants and blood thinners, chronic venous insufficiency, soft-tissue ischemia, risk of cellulitis from the edema, skin changes including pigmentation and itching.

Symptoms:

Homans sign (Slight pain at the back of the knee or calf when the ankle is slowly and gently dorsiflexed (with the knee bent), indicative of incipient or established thrombosis in the veins of the leg.)

Unexplained sharp leg pain in only one leg, sudden edema in only one leg, leg tenderness, increased warmth in the affected leg, changes in the coloration (red) of the affected leg, venous distension (often visible or noticeable by touch).

Diagnosis:

Diagnostic radiological tests are standard protocol for the diagnosis and assessment of deep venous thrombosis.
These tests include contrast venography, duplex ultrasonography, impedance plethysomography and MRI.

Treatment:

The main treatment for deep venous thrombosis has been the use of the blood thinner Heparin. This is started immediately, often through inter-venous application. Within a few days another anticoagulant drug called warfarin is administered. Heparin and warfarin are used together for several days, then warfarin is continued, often for months.

After the resolution of the clot, standard patient treatment protocol will focus on the initial cause of the thrombosis.

Treatment of the thrombosis and associated cause will general resolve leg edema, however a patient may need to wear a compression support hose and undergo therapy for the edema as well.

Possible side effects of treatment may include bleeding and lower platelet counts (thrombocytopenia) from heparin and bleeding from the warfarin as well. Your physician will monitor your situation for these complications and you should tell them immediately should your experience it.

Prognosis:

The patient recovery expectation is excellent as most thrombosis disappear without difficulty. However, they may reoccur therefore it is critical that the patient has long term follow up. It may also be necessary to continue preventative drug therapy for an extended period of time.

(c) Pat O'Connor - Lymphedema People

See Also:

Edema and Deep Venous Thrombosis

For Further Information:

Deep Venous Thrombosis

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Deep Venous Thrombosis

Diagnostic Image Vein

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Deep Venous Thrombosis

Diagnostic Image Leg

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Deep Venous Thrombosis

Venous Pooling

Related Terms:

venous return, deep venous thrombosis, blood clot, venous stasis, chronic venous insufficiency, leg edema, syncope, orthostatic stress, vasoconstriction of arterioles, post phlebitic syndrome, postthrombotic syndrome, Postural Tachycardia Syndrome, venous leg ulcer, venous congestion, lymphedema, venous reflux

Discussion:

Increase in blood contained in veins of lower limbs occurring on standing. Results in fall in pulse pressure and consequential baroreflex increase in heart rate and vasoconstriction of arterioles. Putting it in layman's terms it is simply a poor return of the blood from the legs and feet to the heart. One resulting complication is edema of the affected limb. The edema results from fluid and plasma collecting within the limb instead of processing through the cardiovascular system.

Etiology:

The main cause of this condition is the lack of, or damage to the bicuspid valves in the veins. In the normal pumping action of the heart blood flow is stopped from "backwashing" during the resting period of the heart from these valves. When damaged or when congenitally not there, the blood flows backwards. This can be either congenital or from trauma or disease.

Venous hypertension in diseased veins is thought to cause CVI by the following sequence of events. Increased venous pressure transcends the venules to the capillaries, impeding flow. Low-flow states within the capillaries cause leukocyte trapping. Trapped leukocytes release proteolytic enzymes and oxygen free radicals, which damage capillary basement membranes. Plasma proteins, such as fibrinogen, leak into the surrounding tissues, forming a fibrin cuff. Interstitial fibrin and resultant edema decrease oxygen delivery to the tissues, resulting in local hypoxia. Inflammation and tissue loss result. (1)

Another cause is Postural tachycardia syndrome (POTS). This is a disorder that is characterized by a pulse rate that is too high when the patient is standing. Instead of the blood returning it pools due to the inefficient pump action of the heart. Symptoms of this disorder include rapid heartbeat, lightheadedness with prolonged standing, headache, chronic fatigue, chest pain, and other nonspecific complaints.

Finally, prolonged sitting in cramped position will cause venous pooling. This is especially important to lymphedema patients. On any prolonged trip, patients with this condition should make every effort to move around, stand, stretch or walk.

Symptoms:

The most obvious symptom is the swelling that will occur in the foot and lower leg of the affected limb. Other symptoms may include tight calves, legs and feet that feel "heavy," tired, achy or restless.

Treatment:

Treatment for venous pooling will ultimately focus on the underlying condition that causes it.

For the edema involved, that patient may need decongestive massage therapy to gently move the fluids from the leg or foot. Compression wrappings or compression hosery may be needed as well.

In the condition of the congenital lack of vein valves or in the situation of damaged vascular veins, surgical grafts may be required.

(c) Pat O'Connor - Lymphedema People

See Also:

Edema and Venous Pooling

For further Information:

Chronic Venous Insufficiency (1)

E Medicine

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Chronic Venous Insufficiency

Related Terms:

Edema, lymphedema, post phlebitic syndrome, postthrombitic syndrome, CVI, venous pooling, phlebo-lymphedema, lipodermatosis, ilio femoral disease, venous disease, diabetes millitus

Discussion:

Chronic venous insufficiency is a condition of poor blood return from the lower extremities (feet, and legs) to the heart.

Risk Factors, Etiology:

Age, family history of deep venous thrombosis, sedentary lifestyle, obesity, smoking, deep vein thrombosis, congestive heart failure, diabetes mellitus, occupations that require long term standing.

Symptoms:

Chronic foot or leg swelling in the affected limb, varicose veins, no healing leg ulcers, affected limb may experience pain pressure, itching, dull ache, or heaviness in the affected limb. Skin changes which may include lipodermatosis, fat necrosis, fibrosis of the skin and subcutaneous layers. The skin color may become reddish or brown due to the accumulation of red blood cells.

Complications:

Edema of the affected leg or foot, ulcerations, deep venous thrombosis, pigmentation and pain.

Diagnosis:

Radiological test may be prescribed to verify chronic venous insufficiency. These test may include doppler bi-directional-flow studies, photoplethysmography , outflow plethysmography tests. Other test may include venograms, and duplex ultrasounds.

Treatments:

Treatments will focus on two facets. First the complications of CVI must be treated. This may include decongestive therapy for the edema or swelling. This may include not only decongestive massage and hosiery but compression pump therapy as well. Secondly, treatments will focus on the original cause of the CVI.

These treatments are broken into two categories. First are the non-surgical treatments. These will include leg elevation, compression stockings, use of Unna boots for chronic ulcerations, and injection sclerotherapy.

Surgical intervention will commonly be prescribed for patients who have CVI resulting from the congenital anomaly of weakened or non existent vein valves. In this procedure, competent veins will be graft in replacement of defective veins.

For iliofemoral disease , the operation of choice is a saphenous vein cross over graft. In the procedure, the contralateral vein is mobilized and divided at its distal end. It is then tunneled suprapubilcally and anastomosed to the femoral vein on the deceased side. The result is the diversion of venous blood through the graft and into the intact contralateral venous system. (1)

Other treatments will focus on skin care to relieve itching, and ulcerations. Antibiotic therapy may be required for any infections resulting from the ulcerations.

Long term treatment will naturally focus on the underlying cause of the chronic venous insufficiency.

Diuretics may also be prescribed for a short term therapy.

(c) Pat O'Connor - Lymphedema People

Chronic Venous Insufficiency

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For Further Information:

Chronic Venous Insufficiency (1)

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Chronic Venous Insufficiency

Family Practice Notebook

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Chronic Venous Insufficiency Clinical Resources

Abdominal Edema

Related Terms:

Abdominal swelling, abdominal bloating, lymphedema

Types of Abdominal swelling:

abdominal mass (7) Abdominal swelling type of: Digestive symptoms (397), Abdominal symptoms (272), Swelling symptoms (281) Symptoms: symptom center, symptom list, symptom descriptions, all symptoms

Possible causes of symptom: Abdominal swelling:

The following medical conditions are some of the possible causes of Abdominal swelling as a symptom. There are likely to be other possible causes, so ask your doctor about your symptoms.

Normal child - the stomach of a child protrudes more than adults.
Gas
Swallowed air
Pregnancy
Obesity
Constipation
Chronic constipation (type of Constipation)
Poor muscle tone (see Muscle weakness)
Poor muscle tone after childbirth
Lactose intolerance
Food allergies
Food intolerances
Pregnancy
Hernia
Malabsorption
Irritable bowel syndrome
Colonic bacterial fermentation

Intestinal motility disorders

Gastroparesis
Diabetic gastroparesis

Gas entrapment syndromes

Splenic flexure
Hepatic flexure
Premenstrual syndrome
Pancreatic disease
Acute pancreatitis
Appendicitis

Biliary disease

Gallbladder disease
Gallbladder conditions
Gallstones

Short bowel syndrome
Peptic ulcer
Ascites - see also causes of ascites
Malignant ascites

Intestinal obstruction - causing gas or fluid buildup; see causes of intestinal obstruction

Partial bowel obstructions
Small bowel diverticular
Intestinal adhesions
Intermittent bowel obstruction - see causes of bowel obstruction
Volvulus

Colon cancer
Diverticulitis
Diverticulosis
Ulcerative colitis
Pseudopsiesis
Liver conditions
Cirrhosis of the liver

Certain heart conditions:

Heart failure
Constrictive pericarditis (type of Pericarditis)

Abdominal mass - see also causes of abdominal mass

Certain types of tumors or cancers:

Abdominal tumor
Gastrointestinal tumor
Abdominal cancer
Bowel cancer
Ovarian cancer
Ovarian cystadenoma
Lymphoma

Other:

Fibroids
Organomegaly
Ovarian cystadenoma
Lymphoma
Perforated viscus

Some causes of abdominal distention of infants or children include:

Normal infant pot belly
Premature delivery (see Small baby)
Starvation
Constipation - which may present as runny diarrhea
Cystic fibrosis
Celiac disease
Hirschsprung's disease

WrongDiagnosis.com - Abdominal Swelling

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See Also:

Lymphedema People

All About Lymphedema

Edema or Lymphedema

Peripheral edema

Related Terms:

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral

Definition:

Peripheral edema is an abnormal build-up of fluids in ankle and leg tissues. See also swelling, overall.

Considerations:

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in the lower legs.When squeezed, the fluid will move out of the affected area and may leave a deep impression for a few moments.Swelling of the legs is many times related to systemic causes (for example, heart failure, renal failure, or liver failure).

Common Causes:

Long airplane flights or automobile rides
Menstrual periods (for some women)
Sunburn
Generalized allergy
Prolonged standing
Injury or trauma to the ankle or foot
Venous insufficiency (varicose veins)
Pregnancy (mild to severe swelling)
Environmental
Burns
Insect bite or sting
Starvation or malnutrition
Medical treatments
Body fluid overload
Infiltration of an IV site
Extremity surgery
Medications
Estrogens and progestin oral contraceptives
Blood pressure-lowering drugs
Certain antidepressants (such as Nardil)
Estrogen - oral
Long-term corticosteroid therapy
Nifedipine
Testosterone
Diagnostic tests
Venogram
Congestive heart failure
Glomerulonephritis or other kinds of kidney disorders

Home Care

Elevate the legs above the heart while lying down. Avoid sitting or standing without moving for prolonged periods of time. Avoid putting anything directly under the knees when lying down, and don't wear constricting clothing or garters on the upper legs.

Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down. The pressure applied by elastic bandages or support stockings can help reduce ankle swelling.

A low-salt diet may help reduce fluid retention and decrease the ankle swelling.

Call your health care provider if:

Call your health care provider if ankle swelling persists or worsens after the above measures have been taken.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting ankle, feet, and leg swelling in detail include:

Location

What specific body part(s) swell?
Is there ankle swelling?
Is the whole foot swollen?
Is there swelling over the small bones of the feet?
Is there swelling of the toes?
Is the knee swollen?
Is the whole leg swollen?

Time pattern

Is the swelling always present?
Is it worse in the morning or the evening?

Aggravating and relieving factors

What makes it better?
Does the swelling go down when the legs are elevated?
What makes it worse?

Other

What other symptoms are also present?

The physical examination may include emphasis on the heart, lungs, kidneys, and legs.
Diagnostic tests that may be performed include:
Blood tests such as a CBC or blood chemistry (Chem-20)
ECG
Chest X-ray or extremity X-ray

Intervention:

The specific treatment will be directed at whatever underlying cause is found. Diuretics (fluid pills) may be prescribed. These are effective in reducing the swelling but have some side effects. Home treatment for benign causes of leg swelling should be tried before drug therapy under medical supervision.

After seeing your health care provider:

You may want to add a diagnosis related to ankle, feet, and leg swelling to your personal medical record.Last Reviewed: 10/27/2001 by Jeffrey Heit, M.D., Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

Yahoo Health

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See Also:

Swelling

Arm Lymphedema

Leg Lymphedema

Lymphedema People

Swelling

Related Terms:

Edema, Oedema, Fluid Retention, Water Retention, Swollen Leg, Swollen Arm, Lymphedema, Lymphoedema, arm swelling, leg swelling

Swelling

Swelling is simply defined as the enlargement of an effected body part, generally arm or leg as a result of fluid rentention. It may also effect the skin, organs, hand, fingers, foot and even toes. The fluid collects because the body is not able to eliminate the excess liquids.

It is not uncommon and has been experienced by many many people. Usually, this swelling is temporary and goes away after the underlying condition is healed.

If it effects a specific area i.e. arm or leg it is referred to a localized edema, if it effects the entire over all body it is referred to as generalized.

Temporary Swelling

This temporary swelling may be caused by an infection, burn or sunburn, insect bites, an injury to the leg such as a sprain, surgery, or even medications such a hormone drugs, steroids, blood pressure drugs, or may be an allergic reaction in which is it referred to as angioedema. This may also be an part of the inflammatory response your body goes through it trying to protect and heal the leg or arm from the cause of the trauma.

Long Term Swelling

Long term swelling is referred to as edema. This is usually related to specific medical conditions. These conditions may include diabetes, congestive heart failure, blood clot, varicose veins, kidney failure, liver failure or a number of cardio-vascular problems.

Treatment for this long term swelling is in conjunction with the treatment for the condition that caused it. Usually diuretics are also used to relieve the swelling or water-retention.

Permanent Leg or Arm Swelling

****In the situation of any permanent leg or arm swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg or arm swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg or arm swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg or arm swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg or arm swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the arm or leg.

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown arm lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the hand, or between the elbow and hand. This is an indication of early lymphatic malfunction.

4.) Any inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the arm or leg.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphedema, please visit our home page:

Swelling

(c) Pat O'Connor - Lymphedema People

For further Information

Swelling

All Refer.com Health

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Swelling

Medline Plus

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Diagnostic Images:

Lymphedema Arm Swelling

Leg Swelling

Pitting Edema on the Leg

Edema of the Face

Related terms: Facial swelling, facial swelling, facial edema, puffy face, neck lymphedema, lymphedema of the neck

Important: If you have any type of facial and/or neck edema that interferes with your ability to breathe, you must go quickly to your local emergency room or urgent care center.

Diagnosis:

Diagnosis, like treatment will focus on the causative factor. Included in the work up will a history and physical examination. Blood tests and cultures may be indicated. For long term facial edema radiological tests may be ordered.

Causes:

The most common cause of facial swelling is a reaction to a specific allergen. Other causes include sinusitis, conjunctivitis (eye), facial injury or trauma, infections, stye (hordeolum - eye), drugs (allergic reaction), insect bites and dental abscesses.

Special Considerations:

If there are no external signs or reasons for the facial edema, an internal serious medical condition may be indicated. Special concerns requiring immediate intervention include unknown painless facial swelling, bloody nasal discharge, orbital cellulitis and paratoid swelling with palsey. (1)

Complications:

The most serious and life threatening complication can be anaphylatcic shock. Other complications if caused by infection can be spreading of the infection into other body areas or even sepsis.

Treatment:

As with most cases of edema, treatment will focus on the causative factor. Home treatment may include cold packs to the affected area. Medication to relieve allergic reactions, antibiotics in situations of infections, subsequent treatment of injuries.

Edema of the Face

(c) Pat O'Connor - Lymphedema People

For further Information:

Facial Swelling

University of Maryland Medicine

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Persistent Facial Edema

David Elpern MD - March 21, 2004

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Facial Swelling

familydoctor.org

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Facial Swelling

Discovery Health - Adam Brochert, MD

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Facial Swelling

Yahoo Health

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Facial Swelling (1)

Internal Causes of Facial Edema - doctorupdate.com

Nephrotic syndrome

Related terms:

Nephrosis, Edema, Kidney Failure, Hypertension, Vein thrombosis, Arteriosclerosis, Albumin, Anasarco, NS, Amyloidosis, Congenital nephrosis, Glomerular sclerosis, FSGS, Glomerulonephritis, GN, IgA nephropathy, Berger's Disease, Minimal change disease, MDC, Pre-eclampsia, Osteoporosis, Multiple myeloma, Systemic lupus erythematosus, Mesangiocapillary glomerulonephritis, Diabetes, Hyperproteinemia, Hyperlipedemia, Anarsca, Hyperalbunemia, Membranous Nephropathy, Primary Nephrotic Syndrome, Lipoid Nephorsis, NIL, lymphedema, Pitting edema

Discussion:

Nephrotic syndrome is a kidney disorder in which damage has occurred to the kidneys in the kidney's filtering system called the glomeruli. The resulting central feature is loss of proteins, albumin and globulin in the urine with the subsequent low levels of protein in both the blood. This condition is called proteinuria. Nephrotic Syndrome is a rare condition affecting approximately two in every ten thousand individuals. In children, it is general diagnosed between two and three years old and has a high rate among males than females.

Causes:

The condition can be caused by a multitude factors. These include infection, drug exposure, hereditary disorders, immune disorders, or diseases that affect multiple body systems including diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis (the stiffening and subsequent malfunction of the kidney due to fibrous protein deposit in the tissue) . It can also accompany kidney disorders such as glomerulonephritis, focal and segmental glomerulosclerosis and mesangiocapillary glomerulonephritis.

The following diseases can cause specific damage to the glomeruli and often result in the development of heavy proteinuria and in many instances NS: (1)

Amyloidosis (the stiffening and subsequent malfunction of the kidney due to fibrous protein deposit in the tissue)
Congential nephrosis

Focal segmental glomerular sclerosis (FSGS) (creates scar tissue in the glomerulus, damaging its protein-repellant membrane)

Glomerulonephritis (GN)

Diffuse mesangial proliferative GN (affecting the messangium)

Membranous (damages the protein-repellant membrane)

Postinfectious (occurs after an infection)

IgA nephropathy (Berger’s disease) (deposit of specific immunoglobulin A causing an inflammatory reaction and leading to glomerulonephritis)

Minimal change disease (Nil’s disease)

Pre-eclampsia (rarely associated with NS, more often associated with heavy proteinuria)
In children the most common cause is minimal change disease. A disease of unknown etiology, it cause loss of protein through the urine. It is also difficult to diagnosis because biopsy result show up normal of near normal.

Clinical features:

Patients will present with four main considerations.

1. High levels of protein in the urine
2. Low levels of protein in the blood (hypoalbuminemia)
3. High levels of cholesterol in the blood (hypercholesterolemia)
4. Edema, often severe usually involving the lower legs and feet. This may be referred to as focal edema.

Other clinical symptoms may include frothy urine, anoxrexia, malaise, retinal sheen, abdominal pain and wasting of muscles.

Complications:

Complications can also include renal (kidney) failure, hypertension, susceptibility to infections and blood clotting (thrombosis). Other complications include hypoproteinemia, hypoalbunemia, hyperlipedemia with elevated cholesterols, triglicerides, other lipids and edema.

Nephrotic related edema causes tissues to be soft, puffy and impressionable (pitting edema) to the touch. Initially the edema will be in the legs, but in later stages will progress to abdomen, hands and even around the eyes. In very late stages the entire body may experience swelling (anasarca).In situations of edema, especially with marked edema, the skin may ooze clear fluids and breakdown of tissue is common. While the weeping wound complication of nephrotic syndrome is similar to the weeping wounds of lymphedema, the two condition are distinctly different.

Diagnosis:

In addition to blood tests, and urinalysis, the most important diagnostic tool is a kidney biopsy. The kidney biopsy may reveal the underlying cause and extent or progression of the disease.

Treatment:

The course of treatment for Nephrotic Syndrome includes the various complications. This is referred to as "nonspecific treatment." These treatment include Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications and antibiotics for infections.

Supportive treatment may also include diet, high in quality protein and fiber, but low in saturated fat and cholesterol.

Specific treatment focuses on the underlying causes of the condition.

Treatment for the edema may include diuretics and or decongestive massage therapy.

Treatment of minimal change disease in children usually involves the use of diuretics for the relief of edema and the use of a corticosteroid called prednisone. Minimal Change Disease may also be referred to as Lipoid Nephorsis or NIL Disease.

Other features of treatment may include hospitilization, a prolonged period of treatment, frequent monitoring by patients and doctors, administration of drug associated with significant adverse events. (2)

Prognosis:

Patient prognosis depends on several factors. The most important one being the cause or underlying reason for the condition. Also, some patients may have a spontaneous remission while others experience a gradual progression of the condition.

Other factors will include reactions or complications from the treatment modalities. Some of these complications include atherosclerosis (hardening of the arteries), and adverse reaction to steroids. These reactions include osteoporosis, cataracts, increased risk of infections and even diabetes.

Nephrotic Syndrome

(c) 2005 Pat O'Connor - Lymphedema People

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Childhood Nephrotic Syndrome

This fact sheet has been written to tell you some facts about a kidney disease called the nephrotic syndrome. This illness also is called nephrosis or minimal change disease. The brochure will give you and your family information about your child's illness. It will tell you what will happen with this illness. You also should talk to your doctor. The more you know, the more you can help your child.

What do the kidneys do?

The kidneys are two fist-sized organs found in the lower back. When they are working well, they clean the blood, and get rid of waste products, excess salt and water. When diseased, the kidneys may get rid of things that the body needs to keep, such as blood cells and protein.

What is the nephrotic syndrome?

This is an illness where the kidney loses protein in the urine. This causes protein in the blood to drop, and water moves into body tissues, causing swelling (edema). You will see the swelling around the child's eyes, in the belly, or in the legs. Your child will not go to the bathroom as often as usual and will gain weight with the swelling.

Do other kidney diseases cause edema and protein in the urine?

Yes. Edema and protein in the urine are common in other types of kidney disease, especially a disease called glomerulonephritis.

What causes the nephrotic syndrome?

In the majority or cases, the cause is not known. The National Kidney Foundation has active research programs into causes and treatments of the nephrotic syndrome.

Who gets it?

Usually, young children between the ages of 1 1/2 and 5. It happens twice as often in boys as girls. However, children of all ages and adults also can get it.

How can you tell if your child has it?

You may see that your child has swelling around the eyes in the morning. You may think that your child has an allergy. Later, the swelling may last all day, and you may see swelling in your child's ankles, feet and belly.

Also, your child may be:

• more tired & more irritable

• eating less

• pale looking

The child may have trouble putting on shoes or buttoning clothes because of swelling.

How is the nephrotic syndrome treated?

The treatment will try to stop the loss of protein in the urine, and increase the amount of urine. Usually, the doctor will start your child on a drug called prednisone. Most children get better with this drug.

What does prednisone do?

Prednisone is used to stop the loss of protein from the blood into the urine. After one to four weeks of treatment, your child should begin going to the bathroom more often. As your child makes more urine, the swelling will go away.

When there is no protein in the urine, the doctor will begin to reduce the amount of prednisone over several weeks. The doctor will tell you exactly how much prednisone to give your child each day. Never stop prednisone, unless the doctor tells you to do so. If you stop this drug or give your child too much or too little, he or she may get very ill.

Sometimes, your child will stay healthy after treatment. Your child may relapse (get sick again) at any time, even after a long time with good health. Getting sick may happen after a viral infection, such as a cold or the flu.

What problems call occur with prednisone?

Prednisone can be a very good drug, but it has a number of side effects. Some of these side effects are:

• being hungry

• gaining weight

• acne (pimples)

• mood changes (very happy, then very sad)

• being overactive* more chance of infection

• slowing of growth rate

Side effects are more common with larger doses and if it is used for a long time; once prednisone is stopped, most of these side effects go away.

What if prednisone does not work?

If prednisone does not work for your child or if your child has serious side effects, the doctor may order another kind of medicine, called an immunosuppressive drug. These drugs decrease the activity of the body's immune system. They are effective in most, but not all, children. Your doctor will discuss in detail with you the good and bad things about the drug. The side effects of these drugs include: increased susceptibility to infections, hair loss and increased blood cell production.

Parents also should be aware that children taking immunosuppressive drugs may become ill if they develop chicken pox. Therefore, you should notify your doctor any time that your child is exposed to chicken pox while on these medications.

Your child also may be given diuretics (water pills). These drugs help the kidney get rid of salt arid water. The most common water pill used in children is called furosemide. If your child starts to have a problem with vomiting or diarrhea, you should call your doctor as the child can lose too much fluid and become even sicker. Once protein disappears from the urine, diuretics should stopped.

What other problems happen with the nephrotic syndrome?

Most children will have problems only with swelling. However, a child with nephrotic syndrome can develop a serious infection in the belly. If your child has a fever or starts complaining of severe pain in the belly, you should call your doctor at once.

Sometimes, children with nephrotic syndrome get blood clots in their legs. If this happens, your child will complain of:

• severe pain in arm or leg

• swelling of arm or leg

• changes in color or temperature of arm or leg

If any of these things happens, you should call your doctor right away.

What can parents do?

Much of your child's care will be given by you. Pay attention to your child's health, but do not overprotect the child. If your child is ill or taking prednisone, the doctor will recommend a low salt diet. This type of diet will make your child more comfortable by keeping the swelling down. Try to give your child foods that he or she likes, but that are low in salt. Ask the dietitian for suggestions.

Usually, the child will be allowed to drink as much as he or she wants. A child's natural thirst is the best guide as to how much to drink. You should also weigh your child and keep a record of weight to spot a change in the disease.

The first sign that your child is getting sick again is the return of protein in the urine. Because of this, many doctors ask you to check your child's urine regularly. To do this, a special plastic strip with a small piece of paper on the end is dipped into the urine. The paper will change color when protein is in the urine. This test can be done easily at home and it can detect a relapse before any swelling is seen. Check with your doctor to learn how to do the test and how often to do it.

When there is swelling, check that your child's clothing is not too tight because the clothing can rub the child's skin over the swollen areas. This can make the skin raw, and it may get infected.

Your child will probably have this disease several years. It is very important to treat your child as normally as possible. Your child needs to continue his or her usual activities, such as going to school and seeing friends. Your child should be treated just like other children in the family in terms of discipline. Occasionally, your child may not go to school for a time. Your doctor will let you know if this is necessary. Keeping your child out of school or not letting him or her see friends will not change the illness.

Does the disease ever go away?

Sometimes. Even though the nephrotic syndrome does not have a specific cure, the majority of children "outgrow" this disease in their late teens or early adulthood. Some children will have only one attack of the nephrotic syndrome. If your child does not have another attack for three years after the first one, the chances are quite good that he or she will not get sick again.

Still, most children will have two or more attacks, The attacks are more frequent in the first one to two years after the nephrotic syndrome begins. After ten years, less than one child in five is still having attacks. Even if a child has a number of attacks, most will not develop permanent kidney damage. The major problem is to control their accumulation of fluid using prednisone and diuretics. Children with this disease have an excellent long-term outlook.

What else should I know?

1. Most children with the nephrotic syndrome respond to treatment.
2. Most children with the nephrotic syndrome have an excellent long-term outcome.
3. You should feel free to ask your child's doctor any questions.

What if I have more questions?

If you have more questions, you should speak to your doctor. You also can get additional information by contacting your local National Kidney Foundation Affiliate.

What is The National Kidney Foundation and how does it help?

Twenty million Americans have some form of kidney or urologic disease. Millions more are at risk. The National Kidney Foundation, Inc., a major voluntary health organization, is working to find the answers through prevention, treatment and cure. Through its 50 Affiliates nationwide, the Foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of The National Kidney Foundation is funded entirely by public donations.

Childhood Nephrotic Syndrome

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Additional Resources:

Kidney Disorders - Medline Plus

Childhood Nephrotic Syndrome

Nephrotic Syndrome in Adults

Nephrotic Syndrome (2) - eMedicine

Nephrotic Syndrome - Pediatrics on Call

Nephrotic Syndrome

Nephrotic Syndrome - Renal Unit of the Royal Infirmary of Edinburgh

Membranous Nephropathy

Minimal Change Nephropathy