Swelling In The Legs
Swelling in the legs (ankles, calves or even up to thighs) happens when there is a retention of the fluids, the medical term for swelling is oedema.
There are multiple causes of oedema in the legs. Each one will be approached, managed and treated differently. Bullet points to know are:
If you have swelling in the legs followed by shortness of breath or struggling to breath
And (or) you feel chest tightness, pain or have heavy feeling in the chest, you have to consider calling 999. These symptoms potentially can be suspicious of a blood clot in the lungs.
According to www.nhs.uk website you may need to consider calling 111 for advice if swelling is in one ankle only and there was no apparent cause (such as injury), the swelling is severe, painful and started suddenly, the swollen area is red and feels hot to the touch, your temperature is very high, you feel hot or shivery or you have diabetes.
Swelling caused by heart conditions usually is more or less equally distributed on both sides. Leg oedema caused by heart problems is usually a symptom of heart failure and could be part of the following heart conditions.
Obesity
Even in the absence of pronounced heart condition obesity can cause swelling in the legs. Usually there is not one single factor contributing to the swelling of the legs in obesity. Being significantly overweight can cause diastolic dysfunction of the heart and with this patient may have increased intracardiac pressure on the left side. That in turn makes the right heart work harder, and over time, the right side of the heart becomes more tired and is not able to circulate all the blood coming from lower extremities. The result is fluid accumulation in the legs. Many other factors in obesity contribute to leg oedema, like impaired lymphatic drainage or changes in the veins of the legs.
Cardiomyopathy
Either the ongoing heart muscle problems or sometimes it might be a so-called arrhythmogenic cardiomyopathy due to the heart going too fast for too long.
Pulmonary Artery Hypertension (PAH)
It can be a Primary PAH when there is no other explanation of significantly increased pressures of Pulmonary Artery and the right side of the heart. This condition is rare, more common for female patients. A much more common situation is so-called secondary Pulmonary Artery Hypertension when the pressure in Pulmonary artery and right side of the heart is a consequence of the problems on the left side of the heart or problems of the lungs (like asthma, COPD, pneumonitis).
Chronic Pericarditis
Chronic inflammation of the pericardium (sac around the heart) that becomes thickened and restricts free movement around the heart. This condition is infrequent.
To rule out the cardiac cause of leg oedema, a Cardiologist will take a detailed history, assess blood tests, baseline ECG, you may need an echo scan of the heart and sometimes a heart monitor or other cardiac tests.
The other conditions that can cause oedema in the legs are acute or chronic kidney failure, nephrotic symptom, chemotherapy, liver disease (cirrhosis), thrombophlebitis, deep vein thrombosis (DVT), lymphoedema, chronic venous insufficiency, chemotherapy, pregnancy, or standing or sitting for a long time (during long haul air flights).
The side effect of medications. Some of the antihypertensive medications are known to cause swelling; the most common being Amlodipine or Nifedipine. Nonsteroidal anti-inflammatory medications like Ibuprofen, Naproxen, Celecoxib or sometimes even Aspirin can cause issues. Also, hormone therapy medications that contain estrogen or progesterone as well as Metformin, diabetes drugs or some antidepressants can also cause swelling in the legs.
Swelling in the leg(s) can also be caused by inflammation due to rheumatoid arthritis, mechanical leg injury (bones or tendons), Baker’s cyst, burns, cellulitis, knee bursitis, osteoarthritis, erysipelas, gout, wound.