Edema - Yikes!

Heart failure often causes edema. Congestive heart failure or CHF is the bunch of symptoms that hit you when your heart can't pump enough blood to satisfy your body's needs.
     Your lungs take in the oxygen you breathe and put it into your blood. Your heart pumps that oxygen-rich blood out of your lungs into the rest of your body. Blood then goes back through your lungs, picking up oxygen again, and the cycle repeats (we hope!).
     A weak heart can't pump hard enough to keep up with this cycle. It receives more blood from your lungs than it can pump out into your body. The blood it can't handle backs up and seeps out of your blood vessels into other tissue, including your lungs. Cells get waterlogged. This causes swelling called edema. Edema usually - but not always - shows up first in your legs and ankles.

anklesWhy does it usually show up in your legs and ankles? Because good old gravity is pulling all that "loose" fluid straight down. Presto: your feet and ankles look like the Goodyear blimp. This is very scary the first time it happens to you, believe me.
     Different people are different, though. I swell in my face and stomach, then my hands, then my feet and ankles. Other people swell just in their abdomen, which is called ascites. In men, the genitals can swell, and trust me guys, it isn't the kind of enlargement you hoped for!
     There may be proteins in the blood (fluid, really) that leak into your tissues. If the fluid just sits there long enough, scar tissue can form. This may become a chronic type of edema called brawny edema.
     With edema, sometimes if you press your thumb into your swollen ankle, it doesn't spring right back. It may take as long as 20 minutes to fill back out. This is called pitted edema. It's all caused by your weakened heart, and it's all called edema.

How Do I Prevent It?

neck veinsRead The Manual! Stick to a low sodium diet, do regular moderate exercise, take your meds properly, and maybe restrict your fluid intake. This will do more to keep edema away than than taking more drugs. I know - I have heart failure too.
     No amount of drugs will stop edema if you eat a high sodium diet, keep smoking and drinking, never exercise, and only take your meds when you feel like it. That's just a very tired old fact. When fighting edema, life style is critical.
     You must weigh yourself every morning at the same time in the same clothes - none (this keeps things consistent). If you gain more than 2 to 3 pounds in 24 hours, you probably have edema whether you see it or not. Have a talk with your CHF specialist about this before it happens.
     If your weight shoots up like that, you and your doc will agree that you can take some extra diuretic (like furosemide) and be even stricter on your low sodium diet for a week. You may need to restrict your fluid intake to 2 liters per day as well.

What to do?!

brawny edema in legIf you don't do this and the lining of your stomach gets "waterlogged," your diuretic pills won't work very well. That's because the pill is absorbed partly through the stomach lining. When that lining is congested with extra fluid, the pills don't absorb well, so they don't work well.
     At that point, the usual routine is to get some IV diuretic (furosemide, torsemide, etc.) in your cardiologist's office. That often does the trick. If that still doesn't do it, you should have an echo to check for reduced heart output. After that point, treatment may vary a lot depending on your individual situation.
     Your CHF doctor may raise your ACE inhibitor dose to ease your heart's work load. He may increase your daily diuretic dose or add a second drug like zaroxolyn to make Lasix work better (take zaroxolyn 30 minutes before your Lasix). He may start you on spironolactone (Aldactone). You may need to rest for longer periods or more often.
     If changes in life style and meds don't stop edema, IV drugs or implanted devices like a pacemaker may be tried to help your heart chambers beat more effectively as a "team." As a last resort, heart transplant may be an option.

But what if it's bad now?!

edema in handsHead for your local hospital emergency room. Be sure you have a wallet card or paper with you listing all your meds, prior test results, EF, and other important information about your health (or lack of it <g>). IV diuretics will probably be the course of action, just on a more hurried basis. You're gonna have to see your CHF doc tomorrow though, to see if meds changes are needed to prevent more of the same.
     Please note: Oral diuretics will not work well - if at all - when you retain fluid in your abdomen. Oral diuretics (pills) are absorbed through the stomach's lining and when that lining is partially "blocked" with a lot of extra fluid, the pills don't absorb properly. That's why a dose of IV Lasix will work where a Lasix pill will not. This is also why it is a must to weigh yourself every morning. That's how you catch it before it gets too bad for pills to work.


Remember

The main thing is - do not panic! This is the most important thing. Even if your edema is so bad it splits your skin from stretching it further than it can go, edema can probably be dealt with one way or another. You will learn when to worry and when not to worry as you live with your heart failure over time.
     Notice how I phrase that: "live with your heart failure over time." If you play it smart and follow the rules in The Manual, you can indeed live with your heart failure for quite some time to come. :-).

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004 Jon C.

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