In people with this condition, the veins are having trouble transporting enough blood all the way to the feet and then back to the heart, so it gathers in the legs. Increased pressure causes the fluid to be pushed out of the blood vessels and into the surrounding tissue, leading to edema. Kidney Disease Edema can occur because the disease leads to extra fluid and sodium in the circulatory system, which then builds up pressure in the blood vessels and leads to swelling.
Kidney disease can cause edema in multiple areas. This causes a declining level of protein in the blood, which can lead to fluid accumulation and edema. Liver Cirrhosis A scarring of the liver tissue, it can lead to abdominal edema. This happens because cirrhosis causes a lack of proteins in the liver, which can lead to increased pressure in the blood vessels and fluid seeping into the abdomen. Severe Lung Conditions Conditions such as emphysema can lead to edema if pressure in the lungs and heart gets too high.
Mild cases of edema will usually go away on their own, particularly if you make certain lifestyle adjustments. More severe cases of edema may be treated with diuretics medications that help your body expel excess fluid in urine. If edema is caused by an underlying health condition such as heart failure, long-term management should focus on treating the underlying condition.
Elevating the Affected Limb Holding the swollen arm or leg above heart level several times a day can help reduce swelling. In some instances, elevating the affected limb while sleeping may also be beneficial. Exercise Moving the muscles in the part of the body affected by edema, particularly the legs, can help pump excess fluid back to the heart.
Talk to your healthcare provider about exercises that are right for you. Massage Firm but not painful strokes around the affected area toward the heart may help stimulate excess fluid to move out of the area. Reduced Salt Intake Too much salt can increase fluid retention and worsen swelling. Talk to your doctor about the best ways to limit sodium intake in your diet.
Compression Your doctor may recommend compression socks, sleeves, or gloves after the swelling has gone down in your limbs to prevent it from recurring. Following a healthy diet that is low in salt and fat, and controlling your other risk factors can reduce the risk of developing this condition.
Diagnosis and management of acute heart failure. Philadelphia, PA: Elsevier; chap Pulmonary edema. Murray and Nadel's Textbook of Respiratory Medicine. Philadelphia, PA: Elsevier Saunders; chap Heart failure: pathophysiology and diagnosis.
Goldman-Cecil Medicine. Updated by: Michael A. Editorial team. Congestive heart failure that leads to pulmonary edema may be caused by: Heart attack, or any disease of the heart that weakens or stiffens the heart muscle cardiomyopathy Leaking or narrowed heart valves mitral or aortic valves Sudden, severe high blood pressure hypertension Pulmonary edema may also be caused by: Certain medicines High altitude exposure Kidney failure Narrowed arteries that bring blood to the kidneys Lung damage caused by poisonous gas or severe infection Major injury.
The standard of care has been shotgun therapy, namely treating patients for both CHF and an acute pulmonary process such as asthma, with both diuretics and beta agonists. Mueller found a reduction in hospital length of stay of three days when BNP levels were utilized. However, this study assumed an average length of stay of 11 days. In addition, although the time to initiation of therapy was reduced in this study from 90 to 60 minutes, the general practice in the US is immediate initiation of shotgun therapy.
In the primary care setting, Wright identified patients with heart failure and revaluated them with or without the Pro-BNP result. BNP is available as a point-of-care test, with results available within 15 minutes. However, other conditions that also elevate right filling pressures such as pulmonary embolus, primary pulmonary hypertension, end stage renal failure, cirrhosis and hormone replacement therapy may also cause elevated BNP levels in this range.
Other serum laboratory values may identify prerenal azotemia or elevated alanine aminotransferase ALT , aspartate aminotransferase AST , or bilirubin, suggestive of a congestive hepatopathy. Mild azotemia, decreased erythrocyte sedimentation rate ESR , and proteinuria are observed in early and mild-to-moderate disease.
Increased creatinine, hyperbilirubinemia, and dilutional hyponatremia are observed in severe cases. Cardiac enzymes and other serum markers for ischemia or infarction may be useful as well. Pleural effusions may be present bilaterally or, if they are unilateral, are more commonly observed on the right. Pulmonary edema is observed as perihilar infiltrates often in the classic butterfly pattern reflecting a PCWP greater than 25mmHg.
Several limitations exist in the use of chest X-rays when attempting to diagnose CHF. Classic radiographic progression often is not found, and as much as a hour radiographic lag from onset of symptoms may occur. In addition, radiographic findings frequently persist for several days despite clinical recovery. Emergency transthoracic echocardiography ECHO may help identify regional wall motion abnormalities as well as globally depressed or myopathic left ventricular function.
ECHO may help identify cardiac tamponade, pericardial constriction, and pulmonary embolus. ECHO also is useful in identifying valvular heart disease, such as mitral or aortic stenosis or regurgitation. Electrocardiogram ECG is a non-specific tool but may be useful in diagnosing concomitant cardiac ischemia, prior myocardial infarction MI , cardiac dysrhythmias, chronic hypertension, and other causes of left ventricular hypertrophy. No defined role exists for invasive monitoring devices such as central venous placement CVP lines.
Time-consuming placement of pulmonary artery catheters has not been shown to prolong survival, even in the coronary care unit and, thus far, has not been well studied in the ED setting. Cardiac catheterization may be necessary for a complete evaluation, treatment and assessment of prognosis.
In patients refractory to medical therapy or with evidence of cardiogenic shock, cardiac catheterization, angioplasty, coronary bypass, or intra-aortic balloon pump IABP may be helpful. Cardiac monitoring and continuous pulse oximetry must also be utilized, and intravenous IV access obtained.
To reduce venous return, the head of the bed should be elevated. Patients may be most comfortable in a sitting position with their legs dangling over the side of the bed, which allows for reduced venous return and decreased preload. Therapy generally starts with nitrates and diuretics if patients are hemodynamically stable. Many other treatment modalities may play some role in acute management. If possible, the underlying cause should be treated as well. This is particularly true for patients with known diastolic dysfunction who respond best to reductions in blood pressure rather than to diuretics, nitrates, and inotropic agents.
Contributing factors must be eliminated where possible, and fluid and sodium restricted. Recent data comparing nasal CPAP therapy with facemask ventilation therapy has demonstrated a decreased need for intubation rates when these modalities are used.
BiPAP and CPAP are contraindicated in the presence of acute facial trauma, the absence of an intact airway, and in patients with an altered mental status or who are uncooperative.
These goals may need to be modified for some patients. Use of diuretics, nitrates, analgesics, and inotropic agents are indicated for the treatment of CHF and pulmonary edema. Calcium channel blockers, such as nifedipine and nondihydropyridines, increase mortality and increase incidence of recurrent CHF with chronic use. Conflicting evidence currently exists in favor as well as against the use of calcium channel blockers in the acute setting - at this time is limited to acute use in patients with diastolic dysfunction and heart failure, a condition not easily determined in the emergency department ED.
First-line therapy generally includes a loop diuretic such as furosemide, which will inhibit sodium chloride reabsorption in the ascending loop of Henle. Loop diuretics should be administere IV, since this allows for both superior potency and higher peak concentration despite increased incidence of side-effects, particularly ototoxicity.
If you are not given a log sheet for this, keep a separate journal for this purpose. Cut back on the amount of salt sodium you eat.
Follow your healthcare provider's recommendation on how much salt or sodium you should have each day. Limit high-salt foods. These include olives, pickles, smoked meats, salted potato chips, and most prepared foods. Read the labels carefully on food packages to learn how much salt or sodium is in each serving in the package.
Remember, a can or package of food may contain more than 1 serving. So if you eat all the food in the package, you may be getting more salt than you think. Follow your healthcare provider's recommendations about how much fluid you should have. Be aware that some foods, such as soup, pudding, and juicy fruits like oranges or melons, contain liquid.
You'll need to count the liquid in those foods as part of your daily fluid intake. Your provider can help you with this.
Lose weight if you are overweight. The excess weight adds a lot of stress on the workload of the heart. Keep your feet elevated to reduce swelling. Ask your provider about support hose as a preventive treatment for daytime leg swelling. Besides taking your medicine as instructed, an important part of treatment is lifestyle changes. These include diet, physical activity, stopping smoking, and weight control. Improve your diet by including more fresh foods, cutting back on how much sugar and saturated fat you eat, and eating fewer processed foods and less salt.
Make sure to keep any appointments that were made for you. These can help better control your congestive heart failure. You will need to follow up with your provider on a routine basis to make sure your heart failure is well managed. If an X-ray, electrocardiogram ECG , or other tests were done, you will be told of any new findings that may affect your care.
Have chest pain or discomfort that is different than usual, the medicines your doctor told you to use for this don't help, or the pain lasts longer than 10 to 15 minutes.
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