Swelling of the feet in heart failure

Author Ольга Кияница


Heart failure is manifested by typical symptoms and leg edema is one of them. People who have the feeling of “pouring the feet and ankles” cannot lead a full life. But after passing the appropriate treatment, a feeling of returning youth appears.

Edema (or oedema) is an abnormal accumulation of fluid in various parts of the body. Fluid may accumulate under the skin, as it occurs in the swelling of the legs (peripheral edema), or in the lungs. Often, the location of the edema can give a first hint to the doctor about the main cause of the resulting pathological condition.

In common people, edema is better known as “dropsy”, although the main origin of medical terin is from the Greek word οἴδημα oídēma, which means “edema”.

The fluid that accumulates in the tissues of edema is called interstitial. The amount of interstitial fluid is determined by the balance of its homeostasis. Increased fluid secretion in the interstitium (i.e., in the intercellular space) is also important.

Video: Chronic heart failure (symptoms, emergency)

What is heart failure?

Heart failure means that the heart cannot pump blood as needed. As the power of the heart muscle decreases, the organs no longer receive oxygen and nutrients in the right amount, which causes their work to be disturbed. This further aggravates the condition of the patient, which may cause other complications.

For example, the kidneys no longer effectively remove water and salt from the body. Against the background of this disorder, fluid accumulates on the periphery of the vascular bed, most often in the leg region. ankles, hands, abdomen and lungs. The body, in essence, becomes overloaded with water. The term used to describe the cause of this condition sounds like congestive heart failure.

Thus, with congestive heart failure (CHF), excessive fluid retention is determined, which causes most people to go to the hospital.

Heart Failure Statistics

  • Heart failure affects about 6 million people in the United States.
  • Each year, nearly 700,000 people are newly diagnosed with the disease.
  • Heart failure is the first cause of hospitalization among people over 65 years of age.
  • Given the aging population, it is expected that the incidence of heart failure will increase dramatically.
  • Recently, researchers on behalf of the American Heart Association have predicted that total medical expenses associated with heart failure will increase from $ 21 billion in 2012 to $ 53 billion in 2030.

Congestive heart failure and leg swelling

Swelling of the legs in CHF is a clinical symptom, while excessive fluid retention throughout the body often puts the health of a patient with heart failure at risk.

In the hospital, patients are prescribed strong diuretics for a week or two, and salt and fluid intake is usually limited. As a result, the work of the lungs, in which fluid could have accumulated before, is improving, there is a decrease in body weight, mainly due to the excretion of water. Swelling in the legs, ankles and in the abdomen decreases. When the amount of liquid decreases as much as possible, the person no longer feels as if he is suffocating, so the discharge is carried out home.

However, in most cases, after returning home from the hospital within a few months, the condition worsens again. The patient returns to his unhealthy habits, poor diet and, perhaps, diuretics are no longer taken.

Symptoms of heart failure and edema of the legs

Initially, patients with heart failure may not be able to detect clinical signs. Sometimes symptoms appear, but then go away on their own. The severity of symptoms can range from minor to extremely pronounced.

Common symptoms of heart failure include:

  • Confused breathing.
  • Chest pain.
  • Fatigue.
  • Decreased concentration
  • Dizziness.
  • Swelling in the abdomen, lower limbs, most often swelling of the ankles and / or feet.
  • Fast or irregular heartbeat.
  • Reduced performance.
  • Persistent cough, sometimes with sputum.
  • Unexpected weight gain (due to fluid retention).

Swelling of the legs (peripheral edema) in heart failure can go through two stages of development:

  1. The liquid collected in the area of ​​the feet by the end of the day, independently by the morning diverges. At this stage of the disease, drug treatment is quite effective and with a change in lifestyle, positive results are achieved.
  2. Peripheral edema does not pass by itself. With the progression of the disease, drug treatment may not be effective.

Characteristic swelling of the legs in heart failure

Symptoms of peripheral edema (swelling of the legs) include swelling of the affected area (s), which causes the surrounding skin to “stretch”. The severity of peripheral edema depends on the severity of HF. It will also increase or decrease as the body position changes. For example, if a person lies on his back, the swelling will not appear on the legs, but will be determined in the region of the sacrum.

The skin over the swollen part seems tight and shiny, and often when a finger is pressed against the affected area of ​​the body, a dent appears. This is called pitting edema.

In some cases, pitting edema, or the formation of pits on the skin due to accumulation of fluid in the tissues, is confused with pastoznost. But in the latter case, there are visual changes in the skin, there may also be luster and increased density of the tissues, but with pressure the dent does not form, that is, the tissue quickly regains its shape. Therefore, pasty is considered to be the previous stage of pitting edema.

The main differences in edema in heart failure from edema of other origin

Sign of Heart failure Nephrotic syndrome Chronic venous insufficiency Angioedema
Edema location On foot On the face On foot On the face
Period of occurrence Gradually Gradually Gradually Suddenly
Presence of symmetry On both legs Symmetrical On one or two legs Most often symmetrical
Presence of pain Missing Missing Missing There may be tenderness at the site of edema.
Change of skin over the place of edema Maybe cyanosis Skin may be pale Brown skin Skin may be pale
Time of appearance In the evening Closer to the morning Constantly After contact with irritant
The nature of edema With pressure remains fossa Soft to the touch Hard to touch Felt elasticity and tension of tissues

Essential drugs in the treatment of edema of the legs

Medical care for marked edema of the legs of cardiogenic origin is to improve the functioning of the heart. Also, drugs that increase the excretion of fluid from the body can be used.

The main treatment regimen may include drugs from the following pharmacological groups:

  • Diuretics - a means of having a diuretic effect. By enhancing renal filtration, diuretics contribute to the elimination of sodium and fluid, which in turn reduces edema and shortness of breath.
  • Aldosterone antagonists - allow you to enhance the removal of fluids from the body. Eplerenone and spironolactone are most commonly prescribed.
  • Cardiac glycosides - most often for edema of the legs against the background of CH, digoxin is used. The drug helps to increase cardiac output while simultaneously slowing the heart rate.
  • Beta-blockers - from this group applies carvedilol, bisoprolol. When used correctly, they can slow down the heart rate, but if severe heart failure occurs, they can lead to a blockade of impulses.
  • ACE inhibitors - perindopril, ramipril is used to improve the condition in heart failure. Helps to reduce the load on the heart by reducing blood pressure.

In severe cases, when medications are ineffective, they resort to surgical intervention in the form of a heart transplant.

Video: Foot swelling causes and treatment of leg edema with folk remedies

Prevention of edema - control of heart failure

The best way to prevent or stop the progression of heart failure is to control the conditions that contribute to the onset of this disease.

Heart failure most often occurs on the background of the following diseases:

  • Coronary artery disease, which is also known as “atherosclerosis”.
  • High blood pressure, that is, “hypertension”.
  • Diabetes.
  • Overweight or “obesity”

To prevent these pathologies, special programs have been developed to strengthen heart health. They operate in various medical centers. Special diets and physical exercises are quite successful, which are often taught by qualified rehabilitation doctors or physiologists:

The main tactics of strengthening the cardiovascular system, aimed at the following:

  1. Reducing the impact of virtually all modifiable (changeable) risk factors for coronary artery disease, including correction of cholesterol, triglycerides, and inflammatory factors, such as C-reactive protein.
  2. Reducing blood pressure to normal or almost normal levels, while it is desirable that without the need for medication.
  3. Decreased blood sugar (glucose) in people with diabetes and reversible conditions such as prediabetes and metabolic syndrome.
  4. Normalization of body weight.

New focus on healthy living

“In recent decades, medical care for heart failure tended to focus exclusively on drug therapy, with little attention paid to lifestyle changes,” said cardiologist Ronald Scheib, MD, FACC, doctor and educator at the Pritikin Longevity Center.

“Today, studies show that improving lifestyles in terms of reducing sodium intake, regular exercise and receiving psychological support can reduce the symptoms of heart failure and significantly improve the quality of life,” says Dr. Scheib.

Healthy for the heart lifestyle can also reduce the likelihood of disease progression, thereby reducing the need for hospitalization.

By following the recommendations on diet, exercise, and other habits given by the American Heart Association, you can alleviate the symptoms of heart failure, slow the progression of the disease, and improve your daily life. In most cases, people with mild or moderate heart failure can often lead an almost normal life.

Scientific findings on leg edema in heart failure

Research on heart failure and a healthy lifestyle.

  • Fruits, vegetables, whole grains

The perennial, still ongoing study involving more than 20,000 medical men has been dubbed “Physician Health Survey.”With his help, it was found that the daily consumption of several servings of fruits and vegetables, as well as a diet rich in healthy cereal components, such as oatmeal, protects the heart from the possible development of deficiency.

  • More vegetable protein, less animal protein

Researchers at the 2016 Annual Cardiovascular Disease Research Sessions of 2016, reported that among the 100,000 postmenopausal women, people with the highest intake of vegetable protein had the lowest risk of developing heart failure.

Excellent sources of vegetable protein are beans and other legumes.

In contrast, those women who consumed the most animal protein along with meat and cheese had the highest risk of developing heart failure.

Such data are good proof that taking medications is not as important as what you have to do every day and what forms the basis of lifestyle, not only in diet, but also in physical activity.

  • Diet exercise

Among 92 overweight and obese patients with stable heart failure, scientists found that 20 weeks of heart-healthy nutrition and aerobic exercise are enough to achieve great benefits in terms of improving overall well-being. It is important that body weight decreases on average by 10%, which corresponds to 11 kg.

In addition, physical exercise intensity, measured as peak oxygen consumption (VO2), increased significantly. VO2 peak is an important indicator in predicting survival in the presence of heart failure.

  • Stress reduction

Stress reduction techniques such as deep breathing, yoga and meditation have been consistently documented to help people with heart failure. It turned out that this relaxation brings its results.

Anxiety causes the heart to work harder and faster, so if you manage to ease the level of anxiety, it has a positive effect on the work of the heart.

  • Multidisciplinary treatment

The researchers assessed the health of 126 men and women aged 70 years and older with congestive heart failure. The results of the analysis showed that multidisciplinary treatment, including healthy heart nutrition, significantly reduced the number of hospitalizations and improved the quality of life.

The widespread practice of multidisciplinary treatment in the care of the growing number of elderly patients hospitalized with heart failure, can significantly reduce the cost of health care. At least that is what leading author Michael W. Rich, MD, and his colleagues at the Jewish Hospital at Washington University in St. Louis and from the Department of Economics, University of Washington, thinks so.

Video: The most powerful tool in the swelling of the legs

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