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Monday, 25 November 2013

Pulmonary vascular disease: Pulmonary edema- The Risk factors

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
Pulmonary edema
Pulmonary edema is defined as a condition of fluid accumulation in the air spaces and parenchyma of the lungs of that can lead to difficult of breathing and respiratory failure.
B. Risk factors
1. High altitude
High altitude pulmonary edema (HAPE) is a noncardiogenic pulmonary edema which typically occurs in lowlanders who ascend rapidly to altitudes greater than 2500-3000 m with early symptoms of HAPE include a nonproductive cough, dyspnoea on exertion and reduced exercise performance(8).
2. Swimming induced pulmonary edema (SIPE)
SIPE can be described as a cardiogenic pulmonary edema, at least in part, since an increased transalveolar pressure gradient has been implicated in the pathogenesis of SIPE. Brain natriuretic peptide (BNP) is used in the clinical setting to differentiate cardiac from pulmonary sources of dyspnea, specifically to diagnose cardiogenic pulmonary edema, according to the study by the Loyola University Medical Center(9).
3. Chronic kidney disease
According to the study by the The VA Medical Center, Chronic kidney disease is often associated with predisposing cardiac risk factors that make patients susceptible to development of flash pulmonary edema(10).
4. Prior history of pulmonary edema
Patients with Prior history of pulmonary edema are at increased risk of recurrent pulmonary edema.
5. Hypertension
Many patients with flash pulmonary edema have preserved systolic left ventricular function and coronary artery disease. Flash pulmonary edema frequently reoccurs in association with marked systolic hypertension, even after coronary revascularization. This suggests that control of hypertension is important and that coronary revascularization may not be adequate to prevent reoccurrence of flash pulmonary edema(10a).
6. History of lung diseases
There is a report of a case of NPE in a middle-aged female patient following a breakthrough seizure in whom an immunological cause for respiratory findings was high on the differential list, based on her past medical history and chronicity of symptoms. Rapid symptomatic and radiological improvement following hospitalization led to the correct diagnosis(10b).
7. Increased vascular permeability
Increased vascular permeability contributes to many diseases, including acute respiratory distress syndrome, cancer and inflammation. studies reveal that pulmonary vascular leakage can be increased by altering extracellular matrix compliance in vitro and by manipulating lysyl oxidase-mediated collagen crosslinking in vivo. Either decreasing or increasing extracellular matrix stiffness relative to normal levels disrupts junctional integrity and increases vascular leakage. The identification of lysyl oxidase and the extracellular matrix as critical regulators of lung vascular leakage might lead to the development of new therapeutic approaches for the treatment of pulmonary oedema and other diseases caused by abnormal vascular permeability, according to the Children’s Hospital and Harvard Medical School, Boston(10c).
8. Etc.

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