Edema in Heart Failure: Causes and Treatment

Edema is a medical definition that characterizes the swelling of soft tissues due to accumulation of fluid in them. With edema, the organs, skin, or other parts of the body may increase. Extra fluid can lead to a rapid increase in body weight over a short period of time. Sometimes people can add a few kilograms while maintaining the fluid, before swelling becomes obvious.

Most often, edema is determined in chronic heart failure, when the body's work is gradually disrupted and the fluid accumulating in the vessels of the legs turns into tissues.

Correct definition of the cause of edema and the passage of appropriate treatment can significantly improve the patient's condition. Otherwise, a person can suffer for a long time and quite a lot. Against the background of a serious course of the disease due to edema, other complications arise and the patient dies.

Video: Edema of the legs with heart disease

Description of edema

The most common type of edema is peripheral edema, when the feet, ankles and / or tibia swell. The causes can be caused by several different diseases, some very serious due to systemic disorders. Others are associated with local abnormalities in the legs. Sometimes the edema is caused by several different factors. Since pathology can be associated with cardiac or vascular diseases, patients with edema are firstly examined by a cardiologist.

Peripheral edema is usually determined by pressing a small area in the swollen part of the leg, after which the fossa formed is retained for some time.

• Edema of the lower extremities is often associated with lesions of the veins in the legs, which do not drain the blood properly, or varicose veins / venous insufficiency.
• Edema in the legs can be caused by the inadequate removal of fluid from the tissues of the legs by the lymphatic system (dysfunction of lymph drainage).
• In rare cases, swelling occurs due to the growth of the tumor in the small pelvis or in the region of the thigh, which blocks blood flow or lymphatic flow.
• Swelling due to leg problems or lymphatic problems tends to develop more strongly if a person is standing or sitting for a long period of time.
• Such circumstances as hot weather, pregnancy or long flights on an airplane can lead to some puffiness, especially for those who are inclined to it, because of problems of venous or lymphatic drainage origin.
• A slight swelling of the legs is common among pregnant women due to a physiological increase in blood volume and pressure from the growing uterus.
• Deep vein thrombosis, or DVT, is another common cause of peripheral edema, which is quite dangerous, especially if it is accompanied by pain, redness, and / or local heat. Blood clots that form in the veins of the lower extremities can be life-threatening if they become irritated and pass through the heart into the lungs (pulmonary embolism).
• Arthritis in the knee or ankles, or traumatic leg injuries can also cause swelling.
• Low protein levels in the blood, whether from malnutrition, liver dysfunction or loss of protein in the urine with kidney dysfunction, can lead to edema.
• If someone has a hyperactive thyroid, then another type of edema, known as myxedema, may occur. In fact, its development is due to the deposition of connective tissue components under the skin, rather than the liquid.
• Some drugs can cause swelling in the legs, such as drugs from hypertension, known as calcium channel blockers.They can cause fluid retention because of potential effects on blood pressure, heart and / or kidneys, leading to swelling. Diabetic drugs can cause swelling or heart failure, and steroids often lead to swelling.
• Increasing the intake of sodium (salt) can help keep the fluid even in healthy people, which causes swelling of the legs, although patients with congestive heart failure or kidney dysfunction are particularly at risk.

Despite the numerous causes that cause swelling, most often the accumulation of fluid in the body is observed with heart failure. This disease is quite severe and unfavorable in its development, therefore, timely measures should be taken to treat the therapeutic effect.

Edema due to heart failure

When the left side of the heart does not work properly, pressure in the pulmonary artery can build up, causing shortness of breath. Increased pressure in the pulmonary artery overloads a small circle of blood circulation, which passes through the lungs. Therefore, heart failure is often referred to as congestive heart failure (CHF). When the height of pressure becomes significant, the liquid can pass through the walls of the alveoli and accumulate in the lungs. A similar pathological condition, known as cardiogenic pulmonary edema, can lead to respiratory insufficiency.

With heart failure, the pressure first rises in a small circle of blood circulation and gradually passes to the right side of the heart - to a large circle of blood circulation. This can lead to the accumulation of fluid in the body, which in turn contributes to the development of peripheral edema or the appearance of swollen feet.

In a more severe course of heart failure, edema can touch the internal organs: the intestine, liver, spleen. The extreme degree of the disease is characterized by the formation of ascites - the swelling of the abdominal cavity as a whole.

Treatment of edema with heart failure

The most effective method of treating edema is to eliminate the underlying cause, that is, heart failure. Since this disease is extremely difficult and difficult, various methods of action are used, up to the implantation of a pacemaker.

A small edema decreases naturally in itself, especially if the affected area is located above the level of the heart.Treatment of severe edema is carried out with the help of drugs that help to remove excess fluid from the body. Such drugs are known as diuretics. When used, fluid from the body is usually excreted through urine. An example of such a diuretic is furosemide. However, the medicines prescribed by the doctor depend on the specific medical history.

Features of diuretics

Diuretic treatment can be initiated with the aim of facilitating edema. The most powerful diuretics are loop diuretics, which are called so because they work in such a part of the kidneys as the loop of Henle.

The renal tubules are small ducts that regulate salt concentration and water balance in the formation of urine.

In clinical practice, the following loop diuretics are most commonly used:

• furosemide (Lasix);
• torsemide (Demadex);
• Butetamine (Bumex) 4
• etakrinate (Edecrine).

Doses of these drugs vary depending on the clinical condition of the patient. They can be prescribed orally, although critically ill patients in the hospital generally receive them intravenously for a faster and more effective response.

If one of the loop diuretics is ineffective, it is combined with a drug that works in the distal part of the renal glomeruli - in the tubules. These drugs are known as thiazide type diuretics. These include:

• hydrochlorothiazide (HydroDIURIL);
• metolazone (Zaroxolyn) similar to the first, but more powerful type of diuretic;
• chlorthalidone (Thalitone);
• methiclothiazide (Enduron);
• chlorthalidone (Hygroton);
• indapamide (Lozol);
• metolazone (Zaroxolyn, Diulo, Mykrox).

When diuretics that work on different parts of the kidney are used together, the response is often more effective than using diuretics from one group (synergistic response).

Side effects of diuretics

Although these drugs are safe, some patients report certain side effects. Most often they include:

• Low level of sodium in the blood.
• Excessive and frequent urination.
• Nausea.
• Imbalance of electrolytes.
• Arrhythmia.
• I'm thirsty.
• Loss of appetite.
• Nausea.
• Muscle cramps.

Some diuretics, such as thiazide, can lead to blurred vision, hypovolemia, or decreased potassium levels in the blood.Also can cause allergic reactions in people who are sensitive to this group of diuretics, violate the level of glucose, uric acid, cholesterol. Patients suffering from diabetes or undergoing treatment for gout are not recommended to take thiazide for the treatment of edema. Additionally, potassium preparations should be prescribed.

Depending on the severity of heart failure, the severity of edema and concomitant pathology, the patient may be prescribed drugs from the following pharmacological groups:

• ACE Inhibitors

Angiotensin converting enzyme (ACE) inhibitors are cardiac drugs that dilate blood vessels. This allows you to increase the amount of blood that the heart pumps, and thereby reduces blood pressure and swelling.

Angiotensin II receptor blockers

Drugs in this group reduce the concentration of certain chemicals that constrict blood vessels. This allows you to increase blood circulation throughout the body. Drugs also change the composition of blood, which leads to a decrease in the accumulation of salt and fluid in the body.

• Antiarrhythmics

These drugs are used to eliminate abnormal heart rhythms (arrhythmias) caused by abnormal electrical activity of the heart.

• Antiaggregants

They are a group of powerful drugs that prevent the formation of blood clots (thrombi).

• Aspirin and its analogues

For more than 100 years, aspirin has been used as an analgesic. Since the 1970s, aspirin has also been used to prevent and treat heart disease and stroke.

• Beta-blockers

They represent the most common group of drugs used to treat hypertension (high blood pressure) and various types of arrhythmia. They are also the main means of treating congestive heart failure.

• Calcium channel blockers

The funds of this group relax the blood vessels and increase the amount of incoming blood and oxygen to the heart.Also reduce the burden on the heart.

• Cardiac glycosides

Among them, the most commonly used digoxin. It is mainly prescribed for congestive heart failure, various forms of arrhythmia. If there is congestive heart failure, then this medicine helps the weakened heart to work more efficiently.

• Nitrates

These medications are mainly prescribed for patients with angina and other coronary artery diseases. They also help relieve chest pain caused by blockage of the blood vessels of the heart.

• Warfarin and other anticoagulants

These drugs help prevent the formation of blood clots. Anticoagulants treat certain types of heart disease.

Long-term therapy of edema is mainly focused on treating the causes leading to their appearance. However, sometimes the accumulation of fluid is associated with the side effect of any other medications, then the doctor should study this question, and make changes to the appointment list.

Frequently asked Questions

• How long does it take to recover?

There is no specific time limit for the treatment of edema. Since this is only a sign, the total time required for complete treatment of edema depends on the medicamental effect on the cause of their appearance. When heart failure can be controlled, the puffiness symptoms partially or completely disappear.

• Are the results of treatment permanent?

Treatment of edema can be carried out continuously or temporarily, and this depends on the stage and progression of heart failure. It is important to point out that the treatment of edema only with diuretics only gives temporary relief to the patient, because these drugs mainly provoke the intensive removal of accumulated fluid from the body through the urine. Therefore, the more controlled the course of heart failure, the greater the likelihood that edema will disappear.

• What are the alternatives to drug treatment?

Treatment of edema is mainly carried out using diuretics. However, this method of influence can be realized by several other and more natural methods. In particular, massage therapy can be carried out, the use of cranberry juice, green tea, apple cider vinegar, coriander seeds, mustard oil positively affects. It is good to practice a diet rich in vitamins, turmeric, ginger, dandelion, oregano oil, cocoa butter, Epsom salt, etc.

Again, to permanently eliminate swelling, you must try to cure the underlying cause, that is, heart failure.

Additional recommendations

Edema on the feet or ankles can reduce the following modes of exposure:

• The patient lies in bed or sits, leaning his feet on the pillows to counteract the force of gravity.
• Foot compression or supporting stockings sometimes help to reduce or prevent swelling, but they are not very suitable for regular use.
• Most often, edema caused by heart failure, diuretics are prescribed.
• Proper nutrition helps keep puffiness under control.

Maintaining a healthy heart

Along with the adoption of medications prescribed by the doctor, changes must be made in the way of life, which can also help to keep the normal state as stable as possible.

Lifestyle changes mainly include:

• Regular weighing - a sudden increase in weight may suggest that too much fluid accumulates in the body.
• Observe the amount of fluid taken and released every day.
• Monitor blood pressure to reduce stress on the heart.
• Refusal to smoke is the most important decision that you can take to live longer and healthier.
• Limitation of the amount of alcohol so that the symptoms of the underlying disease do not progress and help to maintain heart health.
• Periodic movement of the muscles of the edematous region, massaging the affected area and its protection from various infections.

The practice of maintaining a healthy lifestyle includes regular exercise, fast or slow walking every day for at least 15 minutes.

Sitting too long in one position can cause the fluid to stagnate in the muscle tissues of the legs and hands. In such cases it is necessary to pull arms and legs to facilitate the circulation of blood and biological fluids. Gentle massage of the affected area can also help alleviate the condition of a patient who has symptoms of swelling.

With regard to eating habits, a patient suffering from swelling should try to reduce the intake of salt or salt-rich foods in his diet. Instead, it is advisable to practice a balanced diet that includes fresh vegetables and fruits.

In addition, maintaining optimal physical activity can help improve energy, endurance, mood and physical fitness.Regular physical activity also contributes to the improvement of well-being or the elimination of symptoms of the underlying disease.

Video: The most powerful tool for swelling of the legs