Pleurisy: Symptoms, causes, treatments, diagnosis, and prevention
“Water in the lungs” means fluid builds up in the lung’s air sacs and tissue. The fluid blocks oxygen transfer and causes shortness of breath. In many cases for a 56-year-old adult this happens because of heart problems or lung injury.
What it means
Pulmonary edema occurs when fluid leaks into lung interstitium and alveoli. It divides into two major types. One type happens when the heart fails and fluid backs up (cardiogenic). The other occurs when lung tissue or capillaries are damaged and leak fluid (non-cardiogenic).
Common causes in a 56-year-old adult
Cardiogenic causes (most common):
- Sudden worsening of left heart failure or after a heart attack.
- Severe abnormal heartbeat or sudden valve failure like mitral or aortic regurgitation.
- Too much fluid volume in someone whose left ventricle cannot handle it.
These cause high pressure in the lung veins and force fluid into the lung air spaces.
Fluid overload because of kidney problems / renal failure:
- When kidneys fail (acute or chronic), fluid accumulates in the body and may flood the lungs.
- Diabetes and high blood pressure often raise this risk for middle-aged or older adults.
Severe infection, sepsis, or ARDS (non-cardiogenic):
- Pneumonia, sepsis or major inflammation damages lung capillaries so they leak fluid.
- The recent COVID-19 pandemic increased awareness of this type of lung fluid build-up.
Transfusion-related lung injury (TRALI) and transfusion-associated overload (TACO):
- After blood transfusion someone might get lung injury (TRALI) through immune reaction.
- Or too much volume from transfusion may cause overload (TACO) and fluid in lungs.
Other causes:
- A major brain injury (neurogenic pulmonary edema).
- Inhaled toxic gases, severe pancreatitis, high altitude, or extreme negative pressure situations.
Why more cases now
- More people in their 50s and older have heart disease and kidney disease.
- New diagnostics (lung ultrasound, BNP testing, bedside echo) find lung fluid earlier.
- Better awareness of lung-injury based pulmonary edema thanks to COVID and expanded ICU research.
How it happens (mechanisms)
Hydrostatic (cardiogenic): High pressure in lung veins pushes fluid out of capillaries into lungs. The fluid is mostly water with little protein.
Permeability (non-cardiogenic): Injury to the alveolar-capillary barrier makes it leaky. Protein-rich fluid floods alveoli, oxygen transfer fails, and the patient becomes very hypoxic.
Symptoms and clues
- Sudden or gradual breathlessness. Might worsen when lying flat (orthopnea).
- Cough that may bring frothy or pink sputum.
- Fast breathing, low oxygen saturation. Hear crackles in lungs. Raised neck veins and swollen ankles suggest heart-related cause.
- Fever or infection signs, recent transfusion, trauma suggest non-cardiogenic cause.
How doctors figure out the cause
- Chest X-ray: heart-related shows enlarged heart and fluid in lung bases; lung-injury type shows diffuse infiltrates without heart enlargement.
- Blood test for BNP/NT-proBNP: high values suggest heart failure.
- Echocardiogram: checks heart pumping, valves, pressures.
- Lung ultrasound: shows “B-lines” when fluid is in lungs.
- Arterial blood gas and pulse-oximetry: measure oxygen and carbon dioxide.
- Blood tests: check kidney function, cardiac enzymes, inflammatory markers.
- If still unclear: advanced tests (rare) such as invasive monitoring or CT scan.
Treatment basics
Initial steps:
Give oxygen to keep saturation above 90 %. Use non-invasive ventilation (CPAP/BiPAP) if patient is alert but has breathing trouble. If very low oxygen or exhaustion, proceed to intubation and mechanical ventilation.
If heart-cause (cardiogenic):
Administer IV loop diuretics (e.g., furosemide) to remove fluid. Use IV vasodilators (e.g., nitrates) if high blood pressure and fluid overload. Use inotropes if heart is weak and in shock. Then treat the root cause (heart attack, arrhythmia, valve problem). For long term follow heart-failure protocols (ACE inhibitors/ARB, beta-blockers, SGLT2 inhibitors, etc).
If lung-injury cause (non-cardiogenic):
Treat the infection or cause (antibiotics, remove toxin, control inflammation). Use lung-protective mechanical ventilation (low tidal volume strategy) once ventilated. Manage fluids conservatively after stabilising hemodynamics. In very severe cases, use prone positioning or ECMO in specialised centres.
If kidney-related fluid overload:
Diurese aggressively if kidneys respond. If not, use dialysis to remove excess fluid and correct volume status.
Latest research and guidelines (2022-2025)
- New heart-failure guidelines emphasise quick recognition of fluid in lungs as part of acute heart failure and early use of modern heart-failure treatments.
- Research on ARDS and non-cardiogenic edema highlights that the condition differs between patients; trials are underway for targeted therapies like immunomodulation or cell therapies, but standard care remains ventilation and support.
- Studies document the interaction between lung and kidney injury—damage to one organ worsens the other. Fluid management in those with combined lung+kidney disease is an active research field.
- Diagnostics at the bedside (ultrasound, rapid biomarkers) are becoming more standard to distinguish types of pulmonary edema quickly.
When to seek urgent care
If you or someone has any of these signs: extreme breathlessness at rest, oxygen saturation under 90 % on room air, sudden inability to speak full sentences, chest pain like a heart attack, fast and irregular heartbeat—you must go to an emergency service immediately.
Practical advice for a 56-year-old adult
- If symptoms come on suddenly: go to emergency. Basic tests will include chest X-ray, ECG, bloods (BNP, troponin, kidney function), bedside echo/ultrasound.
- If episodes recur: see a cardiologist and nephrologist. Get an echocardiogram, track 24-hour urine output, kidney function tests. Consider screening for sleep apnoea (which can worsen heart failure). Review any medications that cause fluid retention.
- Address risk factors you control: keep blood pressure and diabetes under control, reduce salt intake, stay active, follow heart-health diet, adhere to medications if you have heart or kidney disease.
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