Be careful! Swollen feet may be your heart's cry for help

Author: Zhang Jianjun, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Hua Wei, Chief Physician, Fuwai Hospital, Chinese Academy of Medical Sciences

In daily life, many people may encounter sudden swelling of the feet or legs, and often feel confused and puzzled, wondering whether there is some hidden health risk behind it. In fact, swelling of the lower limbs can be caused by many reasons, among which heart disease is the most well-known possibility. In patients with heart disease, the appearance of edema often indicates impaired heart function or progression of the disease.

There is a close relationship between heart disease and edema. There are many types of heart disease, and different types of diseases have their own characteristics in the mechanism of causing edema. First, let's look at the type of heart failure. When heart function fails, the heart's pumping function decreases, resulting in congestion in the systemic circulation and poor venous return, which increases the venous pressure in the lower limbs and causes water to extravasate to form edema. This type of edema is usually symmetrical and concave, and changes with changes in body position. When the patient is standing, the lower limb edema is obvious; when lying flat, the edema may transfer to the lumbar sacral region.

Figure 1 Original copyright image, no permission to reprint

In addition to heart failure, other heart diseases such as valvular disease, coronary heart disease, myocardial infarction, etc., when the disease develops to a certain extent, may also cause edema. These diseases affect heart function through different pathways, eventually leading to systemic congestion and edema. It is worth noting that edema is not a specific symptom of heart disease. Other systemic diseases such as hypothyroidism, cirrhosis, hypoproteinemia, etc. may also cause edema.

Therefore, when symptoms of edema occur, it is necessary to comprehensively consider the patient's medical history, physical examination, and laboratory test results to determine the cause.

When heart disease causes edema, patients often have a series of clinical manifestations. Patients may experience dyspnea on exertion, breathlessness, and inability to lie flat, which are caused by congestion in the pulmonary circulation due to heart failure. At the same time, patients may also experience systemic symptoms such as fatigue and muscle weakness, which are caused by reduced cardiac output and systemic tissue ischemia.

In terms of diagnosis, cardiac ultrasound is an important tool for evaluating cardiac function. Through cardiac ultrasound, the contraction and relaxation function of the heart can be directly observed, the ejection fraction and the size of the atria and ventricles can be determined, and the degree of heart failure can be evaluated. In addition, blood tests for NT-proBNP or BNP levels are also important means of diagnosing heart failure. These biomarkers can reflect the stress state of the heart and the severity of heart failure.

Figure 2 Original copyright image, no permission to reprint

For edema caused by heart disease, the treatment principles mainly include reducing edema, improving heart function and treating the cause. First of all, for the relief of edema, raising the affected limb to reduce water accumulation is a simple and effective method. However, this method can only temporarily relieve symptoms and cannot fundamentally solve the problem. Therefore, in the case of severe edema, diuretics need to be used to promote urine excretion to reduce excess water in the body.

Secondly, treatment for heart function is crucial, including antihypertensive therapy to reduce the heart's workload, improving valve function to prevent blood reflux, and correcting arrhythmias to ensure that the heart can pump blood effectively. These measures can restore the normal function of the heart, thereby alleviating edema and other symptoms.

Finally, treatment of the cause is the key to preventing the recurrence of edema. For patients with heart failure, the primary cause should be actively treated, such as controlling hypertension and improving myocardial ischemia. At the same time, strengthening lifestyle management, such as quitting smoking and limiting alcohol, exercising moderately, and eating a low-salt diet, can also help reduce the burden on the heart and prevent the progression of the disease.