Cardiogenic Pulmonary Edema Causes
Cardiogenic Pulmonary Edema Causes Understanding the factors that contribute to Cardiogenic Pulmonary Edema is crucial for both healthcare professionals and individuals seeking to manage and prevent this condition.
Cardiogenic Pulmonary Edema occurs when the heart’s ability to pump blood effectively is compromised, leading to fluid buildup in the lungs. This condition is closely tied to heart failure, a condition in which the heart is unable to adequately meet the body’s demands.
Fluid accumulation occurs as a result of the heart’s inability to pump blood efficiently, causing an increase in pressure within the blood vessels. This increased pressure leads to fluid leakage into the air sacs, causing pulmonary congestion and edema.
Throughout this article, we will explore the role of heart failure, left ventricular failure, and other cardiac dysfunctions in the development of Cardiogenic Pulmonary Edema. We will also discuss the diagnostic process, treatment options, and preventive measures that can be taken to manage this condition.
Join us as we dive into the intricacies of Cardiogenic Pulmonary Edema and gain a better understanding of its causes and management.
Understanding Cardiogenic Pulmonary Edema
In order to truly comprehend cardiogenic pulmonary edema, it is essential to delve into its definition and explore the underlying connections between this condition, heart failure, fluid accumulation, and cardiac dysfunction. Cardiogenic pulmonary edema occurs when there is an abnormal buildup of fluid in the lungs, which is primarily caused by heart failure and its impact on the heart’s ability to pump blood effectively.
Cardiogenic pulmonary edema is directly linked to heart failure, a condition characterized by the heart’s inability to adequately pump blood to meet the body’s demands. When the heart fails to pump efficiently, fluid can accumulate in the lungs, leading to pulmonary congestion and edema.
The underlying mechanism behind this fluid accumulation involves the impaired functioning of the heart, specifically the left ventricle. The left ventricle is responsible for pumping oxygenated blood from the lungs to the rest of the body. When it fails to do so effectively, elevated pressure builds up within the blood vessels, causing fluid to leak into the air sacs of the lungs.
Fluid Accumulation and Cardiac Dysfunction in Cardiogenic Pulmonary Edema
Contributing Factors | Effects |
---|---|
Heart Failure | Impaired pumping action leads to fluid accumulation in the lungs |
Cardiac Dysfunction | Diminished heart function contributes to fluid buildup |
Left Ventricle Failure | Inability to adequately pump blood results in increased pressure and fluid leakage into the lungs |
It is crucial to recognize that cardiogenic pulmonary edema is not solely confined to heart failure. Other factors, such as congestive heart failure and various cardiac dysfunctions, can also increase the risk of developing pulmonary edema.
This understanding of cardiogenic pulmonary edema provides valuable insights into its etiology, highlighting the interplay between heart failure, fluid accumulation, and cardiac dysfunction. By gaining a comprehensive understanding of these underlying connections, healthcare professionals can better diagnose and manage this condition, ultimately improving patient outcomes.
The Impact of Heart Failure
In understanding the development of cardiogenic pulmonary edema, it is crucial to explore the relationship between heart failure and the accumulation of fluid in the lungs. Heart failure, a condition characterized by the heart’s inability to pump blood effectively, can lead to cardiac dysfunction and fluid accumulation, ultimately contributing to pulmonary congestion and edema.
When the heart fails to pump blood adequately, it puts strain on the cardiovascular system. This strain causes an increase in the pressure within the blood vessels, including the vessels in the lungs. As a result, fluid can leak from these vessels into the surrounding lung tissue and air sacs, leading to fluid accumulation in the lungs.
Cardiac dysfunction plays a pivotal role in this process, as the heart’s inability to efficiently pump blood out of the heart chamber disrupts the normal circulation and results in backup and congestion in the lungs. This congestion ultimately leads to pulmonary edema and the manifestation of symptoms associated with cardiogenic pulmonary edema.
Heart failure can be caused by various factors, including coronary artery disease, heart valve disorders, and high blood pressure. These conditions can weaken the heart muscle or interfere with its ability to pump blood effectively, creating an environment ripe for fluid accumulation and pulmonary congestion.
Impact of Heart Failure on Fluid Accumulation in the Lungs
To illustrate the impact of heart failure on fluid accumulation in the lungs, consider the following table:
Heart Failure Stage | Cardiac Dysfunction | Fluid Accumulation in the Lungs |
---|---|---|
Stage 1 (mild) | Some impairment in heart function | Minimal fluid accumulation, often asymptomatic |
Stage 2 (moderate) | Reduced heart function | Noticeable fluid buildup, mild symptoms |
Stage 3 (severe) | Significant impairment of heart function | Marked fluid accumulation, pronounced symptoms |
Stage 4 (end-stage) | Severely compromised heart function | Severe fluid buildup, life-threatening symptoms |
This table demonstrates how heart failure progresses in relation to cardiac dysfunction and the subsequent impact on fluid accumulation in the lungs. As heart failure advances, the severity of fluid accumulation increases, along with the associated symptoms and risks.
By recognizing the link between heart failure, cardiac dysfunction, and fluid accumulation in the lungs, healthcare professionals can provide appropriate management and treatment strategies to alleviate symptoms, reduce fluid buildup, and improve overall heart function.
Fluid Accumulation in the Lungs
One of the key features of cardiogenic pulmonary edema is the accumulation of fluid in the lungs, which leads to pulmonary congestion and edema. This occurs when increased pressure within the blood vessels surrounding the lungs causes fluid to leak into the air sacs.
The process of fluid accumulation in the lungs starts with the dysfunction of the heart, specifically the left side of the heart. When the left ventricle fails to efficiently pump blood out of the heart, blood backs up into the lungs, resulting in increased pressure in the pulmonary blood vessels.
This increased pressure causes fluid to be pushed through the walls of the blood vessels and into the air sacs, where oxygen exchange takes place. As a result, the air sacs become filled with fluid, making it difficult for oxygen to reach the bloodstream and leading to symptoms such as shortness of breath, coughing, and wheezing.
To better understand the process, let’s take a look at a table summarizing the key factors involved in fluid accumulation in the lungs:
Factors | Explanation |
---|---|
Heart Failure | Left ventricular dysfunction leads to increased pressure in the pulmonary blood vessels, resulting in fluid leakage into the air sacs of the lungs. |
Pulmonary Congestion | The accumulation of fluid in the lungs causes congestion, impairing the ability of oxygen to reach the bloodstream. |
Pulmonary Edema | The excess fluid in the air sacs can lead to pulmonary edema, resulting in symptoms such as difficulty breathing and coughing. |
By understanding the process of fluid accumulation in the lungs, healthcare providers can diagnose and treat cardiogenic pulmonary edema more effectively. The next section will explore the role of left ventricular failure in the development of this condition.
Role of Left Ventricular Failure
In the development of cardiogenic pulmonary edema, left ventricular failure plays a crucial role. This condition occurs when the left ventricle, one of the four chambers of the heart, is unable to effectively pump blood out of the heart and to the rest of the body. As a result, fluid begins to accumulate in the lungs, leading to the onset of cardiogenic pulmonary edema.
When the left ventricle fails to pump blood efficiently, it causes a backup of blood in the lungs. This increases pressure within the blood vessels in the lungs, ultimately causing fluid to leak into the air sacs. The accumulation of fluid in the lungs leads to pulmonary congestion and edema, resulting in the symptoms associated with cardiogenic pulmonary edema.
This condition is often seen in individuals with underlying heart failure, where the heart’s ability to pump blood is compromised. Left ventricular failure can result from various factors such as coronary artery disease, heart valve disorders, or cardiomyopathy. Additionally, exacerbation of heart failure due to factors like high blood pressure, heart attack, or arrhythmias can also contribute to left ventricular failure and the development of cardiogenic pulmonary edema.
Managing left ventricular failure and treating the underlying heart failure is crucial in preventing and alleviating the symptoms of cardiogenic pulmonary edema. This may involve medications, lifestyle modifications, and medical interventions aimed at improving heart function and reducing fluid accumulation in the lungs.
Other Factors Contributing to Pulmonary Edema
While congestive heart failure and cardiac dysfunction are prominent factors contributing to pulmonary edema, there are other conditions and circumstances that can also play a role in its development.
1. Acute Respiratory Distress Syndrome (ARDS)
ARDS is a severe lung condition characterized by inflammation and the accumulation of fluid in the air sacs. This condition can lead to pulmonary edema, causing difficulty in breathing and decreased oxygen levels in the bloodstream.
2. Kidney Dysfunction
Impaired kidney function can result in the retention of fluid in the body, which can overload the cardiovascular system and contribute to the development of pulmonary edema.
3. High Altitude
Exposure to high altitudes can trigger pulmonary edema in susceptible individuals. The reduced oxygen levels at high altitudes can lead to constriction of blood vessels in the lungs, causing fluid leakage and pulmonary congestion.
4. Lung Infections
Infections such as pneumonia or severe bronchitis can cause inflammation and damage to the lung tissues, disrupting the normal functioning of the lungs and leading to fluid accumulation and pulmonary edema.
5. Medications
Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and chemotherapy drugs, may have side effects that can contribute to the development of pulmonary edema.
6. Exposure to Toxins
Inhalation of toxic substances, such as chlorine or ammonia, can damage the lung tissues and impair their ability to remove fluid from the air sacs, resulting in pulmonary edema.
7. Cardiomyopathy
Cardiomyopathy, a disease that affects the heart muscle, can lead to cardiac dysfunction and heart failure, increasing the risk of pulmonary edema.
Pulmonary Edema Causes | Cardiac Dysfunction | Congestive Heart Failure | |
---|---|---|---|
1 | Acute Respiratory Distress Syndrome (ARDS) | ✓ | ✓ |
2 | Kidney Dysfunction | ✓ | |
3 | High Altitude | ||
4 | Lung Infections | ||
5 | Medications | ||
6 | Exposure to Toxins | ||
7 | Cardiomyopathy | ✓ | ✓ |
The Relationship Between Cardiac Dysfunction and Pulmonary Edema
In cardiogenic pulmonary edema, there is a profound connection between cardiac dysfunction and the development of pulmonary edema. Abnormalities in heart function can lead to fluid accumulation in the lungs, causing pulmonary edema.
When the heart fails to pump blood effectively, it disrupts the normal flow of fluids in the body. This can result in fluid accumulation in various organs, including the lungs. Cardiac dysfunction, such as left ventricular failure, can be a significant contributor to the development of pulmonary edema.
Left ventricular failure occurs when the left ventricle of the heart is unable to adequately pump blood out of the heart. This leads to an increase in pressure within the blood vessels, causing fluid to be pushed into the air sacs of the lungs. The accumulation of fluid compromises lung function and leads to pulmonary congestion and edema.
In addition to left ventricular failure, other forms of cardiac dysfunction, including congestive heart failure, can contribute to the development of pulmonary edema. These conditions can impair the heart’s ability to pump blood efficiently, resulting in fluid accumulation in the lungs.
It is important to note that pulmonary edema can also be caused by factors unrelated to cardiac dysfunction, such as kidney problems, certain medications, or high-altitude sickness. However, in the context of cardiogenic pulmonary edema, the link between cardiac dysfunction and fluid accumulation in the lungs is significant.
Understanding the relationship between cardiac dysfunction and pulmonary edema is crucial in diagnosing and managing cardiogenic pulmonary edema effectively. By addressing the underlying cardiac issues and managing fluid accumulation, healthcare professionals can provide appropriate treatment and improve patient outcomes.
Diagnosing Cardiogenic Pulmonary Edema
Diagnosing cardiogenic pulmonary edema involves a thorough evaluation of the patient’s symptoms, medical history, and physical examination. Healthcare professionals look for specific signs and symptoms that indicate fluid accumulation in the lungs, which can be caused by various underlying conditions, including heart failure.
Common symptoms of cardiogenic pulmonary edema include:
- Dyspnea (shortness of breath)
- Orthopnea (difficulty breathing while lying flat)
- Paroxysmal nocturnal dyspnea (sudden and severe shortness of breath during sleep)
- Coughing with frothy sputum (a mixture of saliva and mucus)
- Wheezing or crackling sounds in the lungs
- Tachycardia (rapid heartbeat)
To confirm the diagnosis and identify the underlying cause of the fluid accumulation, healthcare professionals may perform the following tests:
Diagnostic Tests | Description |
---|---|
Chest X-ray | A chest X-ray can reveal signs of fluid in the lungs, such as an enlarged heart or increased vascular markings. |
Electrocardiogram (ECG/EKG) | An ECG records the electrical activity of the heart and can help identify abnormalities that may be causing or contributing to the fluid accumulation. |
Echocardiogram | An echocardiogram uses sound waves to create detailed images of the heart’s structure and function. It can provide information about heart valve abnormalities, reduced cardiac function, and other factors contributing to the pulmonary edema. |
Blood Tests | Various blood tests, including B-type natriuretic peptide (BNP) levels, can aid in diagnosing cardiogenic pulmonary edema and assessing the severity of heart failure. |
Pulmonary Function Tests | These tests measure lung capacity and airflow to evaluate lung function and rule out other possible causes of respiratory symptoms. |
The diagnosis of cardiogenic pulmonary edema is made based on the combination of clinical symptoms, physical examination findings, and the results of diagnostic tests. Early diagnosis is crucial for initiating appropriate treatment and preventing further complications.
Treatment Options for Cardiogenic Pulmonary Edema
When it comes to managing cardiogenic pulmonary edema, there are several treatment options available. The goal of these treatments is to address the underlying heart failure and reduce fluid accumulation in the lungs, alleviating symptoms and improving overall quality of life.
Medications
One of the primary treatment approaches for cardiogenic pulmonary edema involves the use of medications. These medications are aimed at managing heart failure, controlling blood pressure, and reducing the workload on the heart. Some commonly prescribed medications for cardiogenic pulmonary edema include:
- Diuretics: These help to remove excess fluid from the body and reduce pulmonary congestion.
- Vasodilators: These medications relax and widen the blood vessels, reducing the workload on the heart and improving blood flow.
- Beta-blockers: These medications slow down the heart rate and improve heart function.
- Inotropes: These medications strengthen the heart’s contractions and improve its pumping ability.
Lifestyle Changes
In addition to medication therapy, making certain lifestyle changes can also be beneficial in managing cardiogenic pulmonary edema. These lifestyle modifications may include:
- Limiting sodium intake: Consuming a diet low in sodium helps to reduce fluid retention.
- Monitoring fluid intake: Keeping track of fluid consumption can help prevent fluid overload.
- Quitting smoking: Smoking can worsen heart failure symptoms and should be avoided.
- Engaging in regular physical activity: Regular exercise, as recommended by healthcare professionals, can improve heart function and overall cardiovascular health.
Medical Interventions
In some cases, medical interventions may be necessary to manage cardiogenic pulmonary edema. These interventions may include:
- Ventilation support: Non-invasive positive pressure ventilation or intubation and mechanical ventilation can assist with breathing and oxygenation.
- Intra-aortic balloon pump (IABP): This device helps to improve blood flow and reduce the workload on the heart.
- Coronary revascularization: In cases where coronary artery blockages are contributing to heart failure, procedures such as angioplasty or bypass surgery may be performed to restore blood flow.
It’s important to note that the treatment plan for cardiogenic pulmonary edema will vary depending on the individual’s condition and underlying causes. Decisions regarding the most appropriate treatment approach should be made in consultation with a healthcare professional.
Treatment Options | Description |
---|---|
Medications | Diuretics, vasodilators, beta-blockers, inotropes |
Lifestyle Changes | Limiting sodium intake, monitoring fluid intake, quitting smoking, engaging in regular physical activity |
Medical Interventions | Ventilation support, intra-aortic balloon pump, coronary revascularization |
Preventing Cardiogenic Pulmonary Edema
Prevention plays a crucial role in reducing the risk of developing cardiogenic pulmonary edema. By taking proactive measures to manage heart health and address risk factors, individuals can significantly lower their chances of experiencing pulmonary congestion and its associated complications. Additionally, recognizing the signs and symptoms of heart failure and seeking timely medical attention can help prevent the progression of cardiac dysfunction and the development of cardiogenic pulmonary edema.
Risk Factor Management
Managing risk factors can significantly contribute to preventing cardiogenic pulmonary edema. These include:
- Controlling high blood pressure
- Maintaining a healthy weight
- Avoiding smoking and excessive alcohol consumption
- Managing diabetes
- Following a balanced diet low in sodium and saturated fats
- Engaging in regular physical activity
Regular Check-ups and Monitoring
Regular check-ups with healthcare providers are essential for monitoring heart health and identifying any early signs of heart failure. Through routine examinations, diagnostic tests, and assessments of cardiac function, healthcare professionals can detect and address potential issues before they progress into cardiogenic pulmonary edema. Monitoring fluid levels in the lungs, often through imaging tests like X-rays or echocardiograms, can provide valuable insights into the risk of pulmonary congestion.
Medication Adherence
If an individual has been prescribed medications for heart failure, adhering to the prescribed treatment plan is crucial. Consistent use of medications, such as diuretics and medications to manage blood pressure and cardiac function, can help prevent fluid accumulation and reduce the risk of developing cardiogenic pulmonary edema.
Healthy Lifestyle Choices
Maintaining a healthy lifestyle can significantly contribute to preventing cardiogenic pulmonary edema. This includes:
- Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins
- Engaging in regular physical activity
- Managing stress levels
- Avoiding exposure to environmental toxins
Taking these preventive measures can go a long way in safeguarding heart health, reducing the risk of heart failure, and preventing the development of cardiogenic pulmonary edema.
Preventive Measures | Benefits |
---|---|
Controlling high blood pressure | Reduces strain on the heart and lowers the risk of heart failure |
Maintaining a healthy weight | Reduces the burden on the heart and decreases the risk of cardiac dysfunction |
Avoiding smoking and excessive alcohol consumption | Protects against heart disease and reduces the risk of pulmonary congestion |
Managing diabetes | Helps control blood sugar levels and reduces the risk of heart complications |
Following a balanced diet low in sodium and saturated fats | Supports heart health and prevents fluid accumulation in the lungs |
Engaging in regular physical activity | Improves cardiovascular fitness and reduces the risk of heart failure |
Managing Cardiogenic Pulmonary Edema
Managing cardiogenic pulmonary edema requires a comprehensive approach that combines self-care techniques, medication adherence, and regular follow-up with healthcare providers. By actively participating in your treatment plan, you can help alleviate symptoms and reduce the risk of complications associated with fluid accumulation and pulmonary congestion.
Self-Care Techniques
Self-care plays a crucial role in managing cardiogenic pulmonary edema. Here are some self-care techniques that can help:
- Follow a heart-healthy diet low in salt and saturated fats. This can help reduce fluid retention and ease the workload on your heart.
- Avoid smoking and limit alcohol consumption, as these can worsen heart function and contribute to pulmonary congestion.
- Engage in regular physical activity, as advised by your healthcare provider. Exercise can help improve heart function and overall cardiovascular health.
- Manage stress through relaxation techniques such as deep breathing exercises, meditation, or yoga. Stress can exacerbate symptoms and impact heart health.
- Monitor your weight regularly, as weight gain can be a sign of fluid retention. Consult with your healthcare provider if you notice sudden or significant changes in weight.
Medication Adherence
Medications are an essential component of managing cardiogenic pulmonary edema. It is crucial to take your prescribed medications as directed by your healthcare provider. These medications may include:
- Diuretics: Diuretics can help reduce fluid accumulation and relieve pulmonary congestion by increasing urine production.
- Vasodilators: Vasodilators relax the blood vessels, reducing the workload on the heart and improving blood flow.
- Beta-blockers: Beta-blockers can help regulate heart rhythm, reduce blood pressure, and improve overall heart function.
- Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors help relax blood vessels and reduce fluid retention.
It is important to discuss any concerns or side effects with your healthcare provider and never stop or adjust your medications without their guidance.
Regular Follow-Up
Regular follow-up appointments with your healthcare provider are crucial for the management of cardiogenic pulmonary edema. These appointments allow your healthcare team to monitor your heart function, adjust medications if necessary, and check for any signs of fluid accumulation or worsening symptoms. It is important to attend these appointments as scheduled and communicate any changes or concerns you may have.
Tips for Managing Cardiogenic Pulmonary Edema | Benefits |
---|---|
Follow a heart-healthy diet low in salt and saturated fats. | Reduces fluid retention and eases heart workload. |
Avoid smoking and limit alcohol consumption. | Improves heart function and reduces pulmonary congestion. |
Engage in regular physical activity as advised by your healthcare provider. | Improves heart function and overall cardiovascular health. |
Manage stress through relaxation techniques. | Reduces stress impact on heart health and symptom exacerbation. |
Take prescribed medications as directed. | Reduces fluid accumulation, improves heart function, and relieves symptoms. |
Attend regular follow-up appointments with your healthcare provider. | Allows monitoring of heart function, adjustment of medications, and early detection of complications. |
Conclusion
In conclusion, cardiogenic pulmonary edema is a condition characterized by fluid accumulation in the lungs, resulting from heart failure and pulmonary congestion. Throughout this article, we have explored the underlying causes of cardiogenic pulmonary edema, focusing on the connection between heart failure, fluid accumulation, and pulmonary congestion. It is important to understand that heart abnormalities and cardiac dysfunction can contribute to the development of fluid accumulation in the lungs, leading to the symptoms associated with cardiogenic pulmonary edema.
Furthermore, left ventricular failure plays a significant role in the development of cardiogenic pulmonary edema. The inability of the left ventricle to effectively pump blood out of the heart can cause fluid to build up in the lungs, resulting in pulmonary congestion and edema. Additionally, other factors such as congestive heart failure and various cardiac dysfunctions can also contribute to the development of pulmonary edema.
Diagnosing and treating cardiogenic pulmonary edema requires a comprehensive approach. Healthcare professionals rely on symptoms, physical examinations, and diagnostic tests to accurately diagnose the condition. Treatment options focus on managing the underlying heart failure and reducing fluid accumulation in the lungs. Preventive measures, such as maintaining heart health and seeking timely medical attention for symptoms of heart failure, can help reduce the risk of developing cardiogenic pulmonary edema.Cardiogenic Pulmonary Edema Causes
Overall, a thorough understanding of cardiogenic pulmonary edema, its causes, and treatment options is essential for individuals at risk and healthcare professionals alike. By managing heart health, addressing risk factors, and closely monitoring heart function and fluid levels in the lungs, individuals can take steps to prevent and effectively manage cardiogenic pulmonary edema.
FAQ
What is cardiogenic pulmonary edema?
Cardiogenic pulmonary edema is a condition characterized by the accumulation of fluid in the lungs due to heart failure. When the heart is unable to pump blood effectively, it can lead to an increase in pressure within the blood vessels, causing fluid to leak into the air sacs in the lungs.
How does heart failure contribute to the development of pulmonary edema?
Heart failure can lead to the development of pulmonary edema by impairing the heart's ability to pump blood efficiently. When the heart is unable to pump sufficient blood, it can cause a backup of fluid in the veins, leading to increased pressure in the blood vessels of the lungs and subsequent fluid accumulation in the lungs.
What are the symptoms of cardiogenic pulmonary edema?
The symptoms of cardiogenic pulmonary edema typically include shortness of breath, coughing, rapid breathing, wheezing, chest pain, frothy pink or white sputum, and a feeling of suffocation or drowning. If you experience these symptoms, it is important to seek medical attention promptly.
How is cardiogenic pulmonary edema diagnosed?
Diagnosing cardiogenic pulmonary edema involves a thorough medical history review, physical examination, and various diagnostic tests. These may include chest X-ray, electrocardiogram (ECG), echocardiogram, blood tests, and arterial blood gas analysis, among others, to evaluate heart function, lung status, and oxygen levels.
What are the treatment options for cardiogenic pulmonary edema?
The treatment of cardiogenic pulmonary edema focuses on managing the underlying heart failure and reducing fluid accumulation in the lungs. Depending on the severity, treatment may involve medications to improve heart function, diuretics to remove excess fluid, oxygen therapy, lifestyle changes, and in severe cases, interventions such as mechanical ventilation or surgery.
Can cardiogenic pulmonary edema be prevented?
While it may not always be possible to prevent cardiogenic pulmonary edema, there are measures you can take to reduce the risk. Maintaining good heart health, managing risk factors such as high blood pressure and diabetes, following a healthy lifestyle, and seeking medical attention for any signs or symptoms of heart failure can help minimize the chances of developing cardiogenic pulmonary edema.
Cardiac dysfunction, such as abnormalities in heart function or structure, can contribute to the development of pulmonary edema. Impaired cardiac performance can lead to increased fluid pressure within the blood vessels, resulting in fluid leakage into the lungs. Addressing and managing cardiac dysfunction is crucial in preventing and treating cardiogenic pulmonary edema.