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Last Updated on August 9, 2023

What is Pulmonary Vascular Congestion?

Pulmonary Vascular Disease (PVD) is a term used for conditions related to the blood vessels leading to and from the lungs. It also involves the heart as blood travels from the heart to the lungs and vice versa. Similarly, pulmonary vascular congestion is the enlargement of blood vessels in the lungs. It is usually associated with heart failure. This happens when the alveoli get filled with blood after the blood vessels in the lungs dilate.

What Causes Pulmonary Vascular Congestion?

Certain medical conditions can cause damage to the heart muscles which worsens with time and weakens the heart’s function. This leads to heart failure. Some of the common causes of pulmonary vascular congestion include:

  • Ischemic heart disease 
  • Diabetes 
  • High blood pressure 
  • Arrhythmia 
  • Cardiomyopathy
  • Heart valve disease

How Does Pulmonary Vascular Congestion Present?

The characteristic features of pulmonary vascular congestion include:

  • Shortness of breath 
  • Fatigue
  • Swelling in feet, ankles, abdomen, and veins in the neck

All of these symptoms are caused by a buildup of fluid in your body. When symptoms first appear, you may feel weary and short of breath after performing ordinary physical activities such as climbing stairs.

Symptoms worsen as your heart weakens. After getting dressed or stepping across the room, you may feel fatigued and out of breath. Some people even experience shortness of breath when lying flat on their backs.

Fluid buildup from heart failure leads to weight gain, cough that worsens at night and when lying down, and frequent urination. This cough could indicate acute pulmonary edema. This is a disorder in which too much fluid accumulates in the lungs. This condition necessitates immediate medical attention.

What is the Difference between Active Vs Passive Congestion?

Lung congestion can be broadly classified into active and passive congestion. The etiology of both types is different. Active congestion is mainly caused by irritants and infectious agents. These substances usually cause the alveolar walls to distend with blood. On the other hand, passive congestion is caused by increased blood pressure in the capillaries of the lungs. Hypertension leading to passive congestion may be due to a cardiac disorder or relaxation of capillaries that causes the blood to trickle into the alveoli.

Pulmonary Vascular Changes in COPD & Asthma

The following situations, alone or in combination, can change the pulmonary vasculature of patients with COPD & Asthma:

  • Tobacco smoking 
  • Endothelial dysfunction 
  • Structural and functional lung abnormalities

Pulmonary changes in asthma cause inflammation in the airway vasculature to decrease the lung capacity and airflow. Chronic lung disorders, such as asthma and chronic obstructive pulmonary disease (COPD), cause enhanced bronchial angiogenesis and pulmonary vascular remodeling, resulting in the altered bronchial and pulmonary circulation. Residential cells such as endothelial cells, smooth muscle cells, and pulmonary fibroblasts appear to play an important part in the course of vascular inflammation and remodeling.

Also read: Is COPD contagious?

How is Pulmonary Vascular Congestion Diagnosed?

The first step that your doctor will take in diagnosing pulmonary vascular congestion is physical tests and heart tests. Some of the routine tests include:

1- EKG:

It is a relatively simple and painless process that checks the heart’s electrical activity. It also measures the strength of electrical signals that pass through the heart.

2- Chest X-ray:

It is used to capture images of the structures inside the chest, including heart, lungs and blood vessels. Chest X-ray shows whether the heart is enlarged, or the lungs are filled with fluid.

3- Brain Natriuretic Peptide Blood Test:

BNP (Brain Natriuretic Peptide) hormone is raised during heart failure. This test checks the levels of BNP hormone in your blood.

4- Doppler Ultrasound:

A Doppler ultrasonography measures the speed and direction of blood flow using sound waves. This test is frequently used with an echocardiogram to provide a more complete view of blood flow to the heart and lungs. Doppler ultrasounds are frequently used by doctors to assist in the diagnosis of right-side heart failure.

5- Holter Monitor:

A Holter monitor records the electrical activity of your heart for a full 24- or 48-hour period while you go about your normal daily activities. On your chest, you wear little patches known as electrodes. The patches are linked by wires to a small, portable recorder. The recorder can be fastened to your belt, carried in your pocket, or worn around your neck.

6- Nuclear Heart Scan:

It determines how well blood flows through your heart and how much blood reaches the heart muscle. A tracer, a safe radioactive material, is delivered into your circulation through a vein during a nuclear heart scan. The tracer enters your body and releases energy. Outside of your body, special cameras detect the energy and use it to build images of your heart. A nuclear heart scan can reveal which areas of the heart muscle are healthy and which are diseased.

7- Positron Emission Tomography (PET) Scan:

A positron emission tomography (PET) scan is a type of nuclear heart scan. It indicates the level of chemical activity in various parts of your heart. This test can assist your doctor in determining whether or not enough blood is flowing to certain locations of your body.

8- Cardiac Catheterization:

A catheter is a long, thin, flexible tube that is threaded into a blood artery in your arm, upper thigh, or neck and threaded to your heart during cardiac catheterization. This enables your doctor to examine the inside of your coronary (heart) arteries. During this operation, your doctor will assess the pressure and blood flow in your heart chambers, obtain blood samples, and examine your coronary arteries with X-ray scans.

9- Coronary Angiography:

Coronary angiography is typically performed in conjunction with cardiac catheterization. A dye that may be seen on an X-ray is injected into your bloodstream via the catheter tip. The dye helps your doctor to examine how much blood is flowing to your heart muscle. Angiography can also determine how well your heart is pumping.

10- Stress Test:

Some heart disorders are simpler to detect when your heart is working hard and pounding quickly. You exercise during stress testing to make your heart work hard and rapidly. You can use a treadmill to walk or run, or you can ride a bicycle. If you face difficulty exercising, you may be given medication to increase your heart rate. Heart diagnostics, such as nuclear heart scanning and echocardiography, are frequently performed during pregnancies.


Pulmonary vascular congestion is a debilitating condition that hinders one’s ability to perform day-to-day tasks, resulting in increasing dependency on others. It is important to keep an eye on the symptoms and consult your nearest healthcare provider to rule out any other serious medical conditions.

Dr. Zara Khan

Dr. Zara is a Dentist with expert knowledge in Recruitment tactics. Coupled with her insight into Marketing and her love for understanding medical conditions, she is an integral addition to Revival’s Patient Recruitment Department. She is currently pursuing her MBA in Health and Hospital Management.

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Revive Research Institute, Inc.

28270 Franklin Road
Southfield, MI

T: 248-564-1485