Swimming and Pulmonary Edema Part II
In Monday's post on Swimming and Pulmonary Edema Part I, Katharine, an Ironman Triathlete, told of having pulmonary edema of swimming twice this year and asked if warm up or fluids were involved. US Open Water Swimming also interviewed me about pulmonary edema. Here are some things they asked.
1. What is pulmonary edema and why should swimmers know or be concerned about it?
Edema means too much fluid accumulation. Fluid suddenly fills the lungs. The left side of the heart is not pumping properly. It can cause you to have to stop a race. It can sometimes cause serious illness and death.
2. Is it more likely to occur in cold water?
It seems to be more likely in cold water. It has occurred in surface swimmers and scuba divers in both cold and warm water. Cold is only one of the several proposed causes.
Causes or contributors seem to be things that increase cardiac preload and afterload, including immersion in water, cold water, heavy exercise, negative pressure breathing (like breathing with a snorkel, and swimming with the chest below the surface and even the slight elevation of the head to breathe in), and drinking too much water or other fluids before swimming. Don't drink lots of water before swimming.
3. What are the signs and symptoms?
Unusually shortness of breath (not just fatigue) and coughing bloody froth. No chest pain.
With a stethoscope you can hear rales, an abnormal rattling breathing sound. Chest x-rays show the classic pattern of pulmonary edema. When blood oxygen in the arteries is checked, arterial O2 may be lowered.
4. Do wet suits provide any measure of protection against PE?
Difficult to say since it has occurred in people with and without wet suits. I haven't seen charts where the numbers of each predisposing possibility, like protective garments and temperature, were compared.
5. Can medical personnel easily detect PE?
Pulmonary edema is not subtle. The person is usually gasping and spitting pink froth, and asking for help with a worried look.
A swimmer who develops shortness of breath and cough in a race may have something else like exercise induced asthma.
6. What is the first aid if PE is suspected?
Get them out of the water. Sit them up to elevate the head, if conscious. Give them 100% oxygen by mask, and get them to the emergency facility.
7. If PE is untreated and the athlete continues to the race/swim, what could happen?
Depends how serious. Symptoms can resolve on their own or they can get worse. I wish I knew the future for them, but it's like other injuries. There have been deaths. We wonder how many people who suddenly went under were not drowning but developed pulmonary edema. We have no way yet to tell. Drowning also produces pulmonary edema (after the fact). Repeat cases of pulmonary edema can occur in the same person.
Interestingly, the frothing pulmonary edema occurs in racehorses after hard races. They are blowing bloody nose froth all over, but veterinarians have reassured me that the horses are fine. Any readers who are veterinarians, please tell me more. If a person is frothing, get help.
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