Fluid in the lungs (or pulmonary edema as it’s officially known) is a relatively little-known hazard associated with swimming in open water, warn doctors in the journal BMJ Case Reports after treating a woman with the condition.
advanced age, long distance swimming, cold waterand the female gender risk factorsas they are high blood pressure and pre-existing heart disease. But it often occurs in those who are otherwise fit and healthy, the authors emphasize.
Open water swimming has become very popular with over 3 million enthusiasts in the UK in 2021 alone. But growing evidence points to a link between activity and a condition called swimming-induced pulmonary edema, or SIPE for short.
First reported in 1989, SIPE makes swimmers have trouble breathing and depletes their blood of vital oxygen. It affects an estimated 1-2%. open water swimmers, but the authors say cases are likely underreported.
The woman in question was in her 50s and was a competitive long-distance swimmer and triathlete.
Otherwise fit and in good shape, he had trouble breathing and coughing up blood after attending an open water swimming event in 2015. water temperatures approx. 17°C while wearing a wetsuit. Him symptoms It started after swimming 300 meters.
He had no medical history, but two weeks ago he had had breathing difficulties while swimming in open water, which forced him to leave the event and left him breathless for several days afterwards.
By the time he got to the hospital, his heartbeat was fast and a chest X-ray revealed pulmonary edema. Further scans revealed fluid seeping into the heart muscle; this is a sign of stretching known as myocardial edema. But there was no structural heart disease.
His symptoms resolved 2 hours after his arrival at the hospital. He was discharged the next morning after careful follow-up.
It’s not entirely clear what causes SIPE. But it probably includes increases in arterial pressure in the lungs secondary to the centralization of blood volume in a cold environment, exaggerated constriction of these blood vessels in response to cold, and increased blood flow during physical exertion.
However, relapse is common and has been reported in 13-22 percent of patients. scuba divers and swimmers, say the authors, who suggest a predisposition to the condition. They recommend swimming at a slower pace, in warmer water, without a tight-fitting wetsuit, and avoiding non-steroidal anti-inflammatories such as ibuprofen to minimize risk.
For those experiencing symptoms for the first time, the authors recommend stopping swimming and getting out of the water immediately, then sitting upright and seeking medical attention if needed.
This is just one case, the authors emphasize, whose purpose in reporting this is to raise awareness among doctors and swimmers about a relatively little-known condition.
«The UK Diving Medicine Committee has published a guide for divers. However, there is currently no official national medical guideline on the recognition and management of this complex condition,» they say.
Myocardial edema in case of immersion pulmonary edema – Cause or effect?, BMJ Case Reports (2023). DOI: 10.1136/bcr-2022-251274
british medical journal
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