Leg swelling and heart failure: Edema – Symptoms and causes
Managing Swollen Feet & Ankles Caused by Heart Failure
Your heart is a magnificent organ. Though it’s only about the size of your fist, it manages to pump blood all the way to your toes—at least, it does when it’s healthy.
Unfortunately, the heart can become weakened and gradually fail to pump as well as it should. When this happens, doctors call it “heart failure.” One of the more noticeable features of heart failure is swelling. This is known as heart failure edema and often involves swollen feet and ankles. It can also cause swelling of your hands. Learn more about what causes this swelling—and how to manage it.
Why does heart failure cause swollen feet and ankles?
One of the key functions of your circulatory system is the transport of substances—excess fluid, nutrients, waste products—to other places in the body for use or excretion. When you have heart failure, your circulation slows down and becomes less efficient. Fluid that normally would be picked up by the blood and swept away to the kidneys for elimination instead remains behind in places like the lower extremities.
With heart failure, your kidneys also become less able to remove sodium from the blood. You may know that sodium helps your tissues use and retain fluid. However, when excess sodium can’t be cleared by the kidneys, then abnormal swelling can occur. Heart failure edema may be most noticeable with swollen feet and ankles, but it also can occur in the abdomen. Edema is why people with heart failure should weigh themselves daily. Weight gain can be a sign of fluid retention, even if you can’t see it.
Heart failure edema treatment starts by throwing away your salt shaker.
Sodium (salt) is possibly the biggest dietary culprit in causing fluid retention. The first thing anyone with heart failure should do to improve their overall health is throw away their salt shaker.
In general, you should consume less than 2,000 mg of sodium a day if you have heart failure. Because sodium lurks in most pre-packaged foods, you should read food labels carefully to get a real understanding of how much salt you’re taking in.
Take all your medications as prescribed.
If you have heart failure, chances are your doctor prescribed you a diuretic medication (sometimes referred to as a “water pill”). This medication is a swelling treatment because it helps your body get rid of excess fluid. It’s important you take it exactly as prescribed.
Your doctor may have given you other medications, too, including:
- Beta blockers to slow your heart rate
- Blood pressure pill
- Potassium supplement
All of these medications, when taken in combination, treat various symptoms of heart failure, including swelling. You should never stop taking a heart failure medication just because you are not noticing any swelling.
Monitor your fluid intake.
When you have heart failure, you have to be careful about how much fluid you drink because your body can’t process it efficiently. This includes water, coffee and tea, sodas, juices—any fluids at all.
Of course, human beings cannot survive without drinking water. Talk to your doctor for personalized guidelines about how much fluid you should aim to consume daily, and then measure and track your intake to make sure you’re not having too much.
Put your feet up to help combat swollen legs.
When you have heart failure, your heart pumps less forcefully. This means it can’t push blood through distant veins easily. You can give your heart a “gravity assist” by elevating your feet and legs as soon as you notice them starting to swell. By positioning your feet higher than your chest, blood will literally run back through your veins to your heart more easily.
Ask your doctor about wearing support hose.
Sitting for long periods of time promotes swelling in the feet and legs in anyone, but especially in heart failure patients. If you’re planning to travel by plane, train or car for more than a few hours, ask your doctor about whether or not you could benefit from using compression stockings. These garments squeeze your tissue layers together, making it harder for fluid to find a space to accumulate. Some people, such as those with diabetes, perhaps should not wear support stockings, so be sure to consult your doctor before you make this decision.
Heart failure may be incurable, but many people with the condition enjoy a good quality of life. One of the best things you can do to slow the progression of your heart failure is to manage the fluid retention and swelling that may come along with it.
What is your swollen leg telling you?
If you’re over 60 and your legs are painful and swollen, chances are it’s not related to a heart condition. A more likely explanation is that it’s linked to reduced blood flow through the veins in your legs, said an HonorHealth interventional cardiologist.
“What happens over time is deterioration of valves in our veins as we age,” said Mayurkumar Bhakta, MD. “This causes a decrease in blood flow back to the heart. So blood begins to pool in the legs instead of circulating well, and this can cause swelling. The most common cause of leg swelling in older adults is what we call venous insufficiency.” The second most common cause of leg swelling, he said, is a reaction to certain medications. “Leg swelling is connected to heart problems typically about 10 to 15 percent of the time.”
In those instances, he said, swelling in your legs may be accompanied by:
- Shortness of breath
- Chest pains
- Abnormal heart rhythms
- Swelling in other areas, such as the hands or abdomen
Fluid overload indicates heart issue
“When symptoms appear to be more systemic, when the entire body is affected by an overload of fluid volume, those are the kinds of things that may be heart-related,” he said.
A condition that’s often underdiagnosed even in the face of these symptoms, is pulmonary hypertension, or high blood pressure in the lung.
“Essentially the right side of the heart fails because that side isn’t built to withstand high blood pressures,” Dr. Bhakta said. “The pressures in the lung can climb so high that the right side of the heart can no longer push blood through the lungs’ circulatory system.”
Other heart problems that can be related to leg swelling include:
- Atrial and ventricular septal defects — holes in the heart that are typically diagnosed at birth
- Certain abnormal heart rhythms
- Issues with heart valves
- Left heart failure: Swollen ankles and legs can be a symptom
Is this an emergency?
Chronic swelling in the legs as a symptom by itself isn’t typically a medical emergency, Dr. Bhakta said. “Call and make an appointment with your primary care physician or cardiologist. The biggest concern with vein-related leg swelling, he said, is that the signs also could be connected to pulmonary hypertension.
The first thing your primary care physician or cardiologist likely will do is perform an ultrasound examination of your leg veins and an ultrasound of your heart — an echocardiogram, Dr. Bhakta said.
The most often recommended non-medical treatment is compression stockings, which compress the veins and ensure that blood continues to flow.
If the exam shows that the valve in a leg vein is deteriorating to a significant degree, your doctor may recommend venous ablation. In this procedure, a medical-grade adhesive seals off the damaged vein.
If your doctor determines that your leg swelling is related to pulmonary hypertension or heart failure (when the heart isn’t pumping like it should be), you’ll probably undergo additional tests to determine the best treatment. Treatments for both pulmonary hypertension and heart failure include medications and surgery.
Leg pain and weakness
If you’re experiencing pain or weakness in your legs and have difficulty walking, you may have peripheral vascular disease. Other PVD symptoms include:
- Numbness in your legs
- A sense of cold in the calf or foot, especially compared to the other side
- A change in the color of your legs
- Sores that won’t heal on your feet or legs
- If you’re experiencing these signs of PVD, see your doctor
Leg swelling as a single symptom that lasts more than a few days requires an office visit with a primary care physician or cardiologist, Dr. Bhakta emphasized. There’s about an 85 percent chance that leg swelling is related to chronic venous insufficiency or side effects from medications such as high blood pressure medications called calcium channel blockers or corticosteroids. But you need a health care provider’s direction to determine the cause.
If leg swelling is accompanied by shortness of breath or chest pain, go to the ER.
Types, Causes, Symptoms, and Treatment
“Edema” is the medical term for swelling. Body parts swell from injury or inflammation. It can affect a small area or the entire body. Medications, pregnancy, infections, and many other medical problems can cause edema.
Edema happens when your small blood vessels leak fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell. It can happen almost anywhere in the body.
Types of Edema
Peripheral edema. This usually affects the legs, feet, and ankles, but it can also happen in the arms. It could be a sign of problems with your circulatory system, lymph nodes, or kidneys.
Pedal edema. This happens when fluid gathers in your feet and lower legs. It’s more common if you’re older or pregnant. It can make it harder to move around in part because you may not have as much feeling in your feet.
Lymphedema. This swelling in the arms and legs is most often caused by damage to your lymph nodes, tissues that help filter germs and waste from your body. The damage may be the result of cancer treatments like surgery and radiation. The cancer itself can also block lymph nodes and lead to fluid buildup.
Pulmonary edema. When fluid collects in the air sacs in your lungs, you have pulmonary edema. That makes it hard for you to breathe, and it’s worse when you lie down. You may have a fast heartbeat, feel suffocated, and cough up a foamy spittle, sometimes with blood. If it happens suddenly, call 911.
Cerebral edema. This is a very serious condition in which fluid builds up in the brain. It can happen if you hit your head hard, if a blood vessel gets blocked or bursts, or you have a tumor or allergic reaction.
Macular edema. This happens when fluid builds up in a part of your eye called the macula, which is in the center of the retina, the light-sensitive tissue at the back of the eye. It happens when damaged blood vessels in the retina leak fluid into the area.
Causes of Edema
Things like a twisted ankle, a bee sting, or a skin infection will cause edema. In some cases, like an infection, this may be helpful. More fluid from your blood vessels puts more infection-fighting white blood cells in the swollen area.
Edema can also come from other conditions or from when the balance of substances in your blood is off. For example:
Low albumin. Your doctor may call this hypoalbuminemia. Albumin and other proteins in the blood act like sponges to keep fluid in your blood vessels. Low albumin may contribute to edema, but it’s not usually the only cause.
Allergic reactions. Edema is a part of most allergic reactions. In response to the allergen, nearby blood vessels leak fluid into the affected area.
Obstruction of flow. If drainage of fluid from a part of your body is blocked, fluid can back up. A blood clot in the deep veins of your leg can cause leg edema. A tumor blocking the flow of blood or another fluid called lymph can cause edema.
Critical illness.Burns, life-threatening infections, or other critical illnesses can cause a reaction that allows fluid to leak into tissues almost everywhere. This can cause edema all over your body.
Congestive heart failure. When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid builds up quickly, you can get fluid in the lungs. If your heart failure is on the right side of your heart, edema can develop in the abdomen.
Liverdisease. Severe liver disease, such as cirrhosis, causes you to retain fluid. Cirrhosis also leads to low levels of albumin and other proteins in your blood. Fluid leaks into the abdomen and can also cause leg edema.
Kidney disease. A kidney condition called nephrotic syndrome can cause severe leg edema and sometimes whole-body edema.
Pregnancy. Mild leg edema is common during pregnancy. But serious complications of pregnancy like deep vein thrombosis and preeclampsia can also cause edema.
Head trauma, low blood sodium (called hyponatremia), high altitudes, brain tumors, and a block in fluid drainage in the brain (known as hydrocephalus) can cause cerebral edema. So can headaches, confusion, unconsciousness, and coma.
Medications. Many medicines can cause edema, including:
When they cause swelling, usually it’s mild leg edema.
Symptoms of Edema
Your symptoms will depend on the amount of swelling you have and where you have it.
Edema in a small area from an infection or inflammation (like a mosquito bite) may cause no symptoms. On the other hand, a large allergic reaction (such as from a bee sting) may cause edema on your entire arm that can bring pain and limit your arm’s movement.
Food allergies and allergic reactions to medicine may cause tongue or throat edema. This can be life-threatening if it interferes with your breathing.
Leg edema can make the legs feel heavy. This can affect walking. In edema and heart disease, for example, the legs may easily weigh an extra 5 or 10 pounds each. Severe leg edema can interfere with blood flow, leading to ulcers on the skin.
Pulmonary edema causes shortness of breath and sometimes low oxygen levels in the blood. Some people with pulmonary edema may have a cough.
There may be an indent or a “pit” that remains for a while after you push on the skin in some types of edema. This is called pitting edema. If the tissue springs back to its normal shape, it’s called non-pitting edema. It’s a symptom that may help your doctor figure out the cause of your edema.
Treatment of Edema
To treat edema, you often must treat its underlying cause. For example, you might take allergy medications to treat swelling from allergies.
Edema from a block in fluid drainage can sometimes be treated by getting the drainage flowing again. A blood clot in the leg is treated with blood thinners. They break down the clot and get drainage back to normal. A tumor that blocks blood or lymph can sometimes be shrunk or removed with surgery, chemotherapy, or radiation.
Leg edema related to congestive heart failure or liver disease can be treated with a diuretic (sometimes called a ”water pill”) like furosemide (Lasix). When you can pee more, fluid from the legs can flow back into the blood. Limiting how much sodium you eat can also help.
Leg Swelling Specialist – Greenbelt, MD: Maryland Cardiology Associates: Cardiologist
What is leg swelling?
Leg swelling may affect any part of your lower extremities, including your feet, ankles, calves, or thighs. The swelling may develop from excess fluid or inflammation in your legs.
What causes leg swelling?
Leg swelling may occur from any number of causes. In most cases, the swelling develops after spending prolonged periods of time sitting or standing. However, your leg swelling may also be a symptom of an underlying heart or vascular problem.
Some of the common cardiovascular conditions that cause leg swelling include:
- Congestive heart failure
- Peripheral artery disease (PAD)
- Chronic venous insufficiency
- Deep vein thrombosis (DVT)
- Pulmonary hypertension
Kidney disease may also cause leg swelling.
Though not always a medical emergency, if your leg swelling includes other symptoms such as chest pain, shortness of breath, or dizziness, you should seek emergency medical care.
Leg pain with these other symptoms may be signs of a cardiovascular problem, including a heart attack or pulmonary edema.
What happens during an evaluation for leg swelling?
Maryland Cardiology Associates conducts a comprehensive cardiac exam when you come in with complaints of leg swelling. The goal of the exam is to identify any cardiac or vascular problem that may explain your symptom.
The detailed exam consists of three stages: observation, palpation, and auscultation. To gather all the necessary information your cardiologist needs to diagnose the root cause of your leg swelling, they may conduct various tests such as:
- Stress testing
- Electrocardiogram (EKG)
- Nuclear stress testing
- Holter monitor
- Event monitor
- Upper and lower arterial duplex scan
- Venous duplex scan
- Renal ultrasound
The professionals at Maryland Cardiology Associates are highly trained and take great steps to make you feel comfortable during your exam and testing.
How is leg swelling treated?
Treatment for your leg swelling may depend on the underlying cause. Your cardiologist at Maryland Cardiology Associates customizes a plan to match your needs and goals.
Treatment may include:
- Following a healthy diet
- Adding regular exercise
- Not sitting or standing for a prolonged period of time
- Elevating your feet
- Wearing compression stockings
- Prescribing medication to manage high blood pressure or high cholesterol
Maryland Cardiology Associates also performs vascular procedures to treat various conditions that cause leg swelling, including atherectomy or angioplasty and stent placement for PAD.
To schedule your comprehensive cardiac exam at Maryland Cardiology Associates, call the office or book an appointment online today.
Treatment of Edema – American Family Physician
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Types of Heart Failure | American Heart Association
Left-sided heart failure
The heart’s pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart’s pumping power, so it’s larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.
There are two types of left-sided heart failure. Drug treatments are different for the two types.
- Heart failure with reduced ejection fraction (HFrEF), also called systolic failure: The left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
- Heart failure with preserved ejection fraction (HFpEF), also called diastolic failure (or diastolic dysfunction): The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart can’t properly fill with blood during the resting period between each beat.
Right-sided heart failure
The heart’s pumping action moves “used” blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen.
Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver (causing ascites).
Congestive heart failure
Congestive heart failure (CHF) is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body’s tissues. Often swelling (edema) results. Most often there’s swelling in the legs and ankles, but it can happen in other parts of the body, too.
Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress.
Heart failure also affects the kidneys’ ability to dispose of sodium and water. This retained water also increases swelling in the body’s tissues (edema).
Dr. Gott: Congestive heart failure causes leg swelling
Peter H. Gott, M.D.
Dear Dr. Gott: My mother is 80 years old and was diagnosed with congestive heart failure about two years ago. In November, her left leg started to swell and is still swollen after 14 trips to the doctor. It is so bad that the lymph fluid is oozing through her pores into her socks. Her shoes don’t fit. She does not have diabetes. Her main doctor, an internal-medicine specialist, has referred us to a dermatologist with no results. She has had a deep-vein-and-artery scan. Now we have been referred to a vein-and-artery surgeon who wants her to have an angiogram. Her leg is gruesome, and I don’t see the light at the end of the tunnel. Could this lymphatic swelling have to do with her congestive heart failure? We haven’t been to a cardiologist. Please help.
Dear Reader: Leg edema (swelling due to inappropriate fluid retention in the lower extremities) is often the hallmark of inadequately treated congestive heart failure, when the weak heart action fails to circulate enough blood through the kidneys. As a result, instead of being excreted, the excess fluid pools in the legs.
I strongly urge your mother to see a cardiologist. I am disappointed that your mother’s internist hasn’t urged her to see such a specialist. She should have begun seeing a cardiologist on a regular basis (one or two times a year) as soon as the diagnosis was made. A cardiologist is the best choice for treatment options, monitoring and controlling CHF.
A vascular surgeon will be of little help in the treatment and management of your mother’s ailment because it may be cardiac, not vascular.
If I am correct that CHF is the basis of her problem, the disorder is treated easily with drugs that strengthen the heartbeat and drive the fluid out of her legs by way of the kidneys.
To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.
Dear Dr. Gott: With new types of water beverages “springing” up everywhere, I was wondering especially about the new sugar-free, sodium-free, zero-calorie, zero-carb, zero-caffeine, carbonated, fruit-flavored water. Does this carbonated water carry the same benefits as regular tap (or bottled) water?
Dear Reader: I cannot answer your question because although I assume the product has been spiked with carbonation (harmless) and fruit flavor, I am not aware of any secondary health consequences. As you know, water is a natural source of hydration and is a necessary component of human nutrition. Some additives are dangerous, some are harmless. But the fact that your water is free of sugar, sodium, calories, carbohydrates and caffeine makes it just that: water.
My advice? Drink plain water if you’re thirsty, reserving the sparkly fruit-flavored drink for a treat.
90,000 treatment, diagnosis, prevention, signs – 8 (495) 120-02-05
In case of heart failure, edema is observed quite often. They are localized depending on the characteristics of the disease that caused the heart failure, and on the specifics of the pathology of the functioning of the heart muscle.
At the initial stages of chronic heart failure, the legs begin to swell in the evenings or after prolonged exertion on the limbs in an upright position.They disappear after a short rest or when changing body position. But subsequently, as the disease progresses, edematous phenomena also progress. Even a long rest does not help.
Initially, edema is localized on the legs, from the toes and feet, the swelling gradually spreads higher and higher, to the thighs and lower abdomen, while the area of edema also increases. At the same time, the legs swell symmetrically. Cyanosis is often observed in the area of edema.
Edema appears regularly, and their manifestations only get worse over time.On palpation, the area of edema is firm to the touch. If you press on the edema, then a fossa appears in its place, which soon disappears. Cardiac edema is characterized by a symmetrical arrangement. In the later stages of the development of the disease, edema is accompanied by shortness of breath. In bedridden patients, swelling appears in the pelvis and lower back. Acute heart failure can lead to pulmonary edema.
Often, edema is accompanied by tachycardia, pallor, blue lips, swelling of the face, fatigue, chronic fatigue syndrome.In the later stages, the liver increases in size, abdominal dropsy appears.
In case of edema, it is very important to be in a state of physical and mental rest. It is necessary to observe the daily regimen, sleep about 9-10 hours a day. Daily therapeutic exercises, walks in the fresh air are useful. Wearing elastic bandages or stockings can also be effective.
Food should be fortified and balanced. You need to follow a salt-free diet and limit fluid intake to 1 liter per day.The diet requires foods with a high potassium content: potatoes, cabbage, cucumbers, eggplants, parsley, onions, buckwheat, raisins, dried apricots, nuts. Additionally, a cardiologist may recommend nutritional supplements: magnesium, thiamine, amino acids, and the like.
To get rid of edema, first of all, it is necessary to remove the symptoms of heart failure and achieve their compensation.
If the edema is not yet very pronounced, massage, foot baths, compresses, rest with high legs are useful.After consulting a doctor, it is possible to use herbal diuretics: infusion of birch leaves, lingonberry leaves, infusion of cornflower flowers, horsetail decoction. But they are effective only at the initial stage of the onset of edema.
When “home” remedies do not help, drug treatment is prescribed: diuretics, ACE inhibitors, cardiac glycosides are prescribed. In severe forms of edema, the patient is hospitalized.
In severe cases, surgical treatment is performed: fluid from the abdominal cavity is extracted through laparocentesis, and pleural puncture helps to remove fluid from the lungs.
It is very important to see a doctor and be examined at the first sign of swelling. Correctly selected treatment relieves symptoms of heart failure, normalizes heart function and promotes the rapid removal of excess fluid from the body.
However, swelling cannot be cured at once. You need to undergo several courses of treatment, usually they are prescribed every three months. In more complex cases, constant medical supervision and regular treatment are necessary.
Regional Skin and Venereal Diseases DispensaryLipetsk
Swelling of the upper and especially lower eyelids on the face in the morning, it is difficult to fasten boots in the evening, and shoes, well dressed in the morning, begin to unbearably squeeze the legs, deep imprints from the elastic of socks appear on the skin….
The cause of edema can be many diseases How often do we have to deal with such phenomena! But these symptoms are not always safe, because these are the first signs of edema syndrome. Edema, especially pronounced, is always a manifestation of a disease of any internal organ or vessels.They themselves will not pass, and if you do not pay attention to them, then subsequently serious health problems may arise.
So where do you start? First, you need to find out the reason why the legs and / or face began to swell. There are many diseases and conditions that are accompanied by edema, so differential diagnosis should be carried out by a specialist – a doctor.
Major diseases accompanied by edema
- Varicose veins of the lower extremities.
- Kidney disease (pyelonephritis, glomerulonephritis, etc.).
- Heart disease (ischemic heart disease, defects, cardiomyopathy, etc.).
- Liver diseases (cirrhosis).
- Diseases of the endocrine system.
- Disorders of lymph outflow, the so-called elephantiasis.
One of the causes of leg swelling is varicose veins of the lower extremities Varicose veins of the lower extremities is one of the main reasons why legs swell.Most common in women. Normally, veins are involved in blood circulation, their walls have some “strength” – a tone, due to which the blood returns back to the heart against hydrostatic pressure, at the height of human growth. The valves inside the veins also keep the blood from going down. In case of varicose veins, the veins have slightly weaker walls, and under some conditions (for example, prolonged work standing on their feet, pregnancy, etc.) do not withstand pressure and expand, take on the form of “bags”, knots, cords.The return of blood decreases, it stagnates in the veins, and its liquid part goes into the tissue – edema occurs. The longer a person spends on his feet, the stronger the swelling. They occur mainly on the legs and are accompanied by heaviness, pain in the legs (or one leg). The swelling grows in the evening, goes away or decreases overnight. If varicose veins have existed for some time, then the color and moisture of the skin changes, spots may appear, hair may fall out. The dilated veins are not always visible through the skin.There are deep veins that are not visible.
Varicose veins are dangerous by the addition of thrombophlebitis – inflammation of a vein with the formation of a thrombus inside it – a blood clot. Blood clots can break off from the vein wall and be carried by the blood stream into the lungs – there they clog the vessel and a pulmonary infarction is obtained. It is better not to allow this and be treated (or operated on) in time by an angiosurgeon (vascular surgeon).
Edema with kidney disease
Edema in case of kidney disease is possible even on the hands Edema in case of kidney disease may first appear on the face, especially the eyelids, and then on the ankles, legs and even higher: hands, abdomen.Moreover, they appear in the morning, by the end of the day they increase on the legs. The skin is not changed, warm, maybe a little pale. Their occurrence is associated with the difficulty in excreting salts and water by diseased kidneys (excess water remains in the body), as well as protein losses through the kidneys (protein normally keeps water in the bloodstream, prevents it from seeping through the vascular wall into the tissue). Quite often, edema is the first symptom of kidney disease, since both pyelonephritis and glomerulonephritis can flow latently for several years.
Swelling with heart disease
Arterial hypertension and ischemic disease (angina pectoris) are the scourge of our time. Their prevalence is enormous. And then there are heart defects, cardiomyopathies … Any disease that damages the heart muscle (myocardium) causes a decrease in the contractility of the heart, weakens it and, after a while, contributes to the appearance of heart failure. Those. a situation arises in which it becomes difficult for the heart to pump the entire volume of blood and part of it remains, so to speak, on the periphery (more often in the lower extremities).Its liquid part seeps into the tissue – edema appears. Usually, with heart failure, kidney function is also impaired (reversibly), they do not remove excess fluid and salt, which increases edema.
Edema in heart failure increases over several days and weeks, the skin is usually pale, cool, sometimes with cyanotic swelling. They are accompanied by symptoms such as weakness, palpitations during exertion, shortness of breath, changes in pressure, there may be pain and interruptions in the work of the heart (uneven pulse).
Edema in liver diseases
Liver diseases are characterized by swelling of the abdomen. Liver diseases themselves (hepatitis, hepatosis) do not lead to edema. Edema appears at the stage of complications, if the disease turns into cirrhosis. With cirrhosis, water is also retained in the body, moreover, the suffering liver does not produce enough protein, the so-called oncotic blood pressure drops, and fluid is not retained in the bloodstream.
Feet, legs, thighs, abdomen may swell (especially characteristic!).They are accompanied by yellowness of the skin and eyes, bruises on the skin, weakness, heaviness in the right side, weight loss, and sometimes a significant increase in the liver.
They have a rather characteristic picture and are usually accompanied by reddening of the skin, itching and often a rash. At the same time, the skin on the face, neck swells, in severe cases, the swelling of the skin spreads to the entire body. In this case, hoarseness, nasal congestion, lacrimation are also possible.These symptoms occur after contact with an allergen: a certain food product (citrus fruits, fish, etc.), medicine, aerosols, etc.
Dense myxedema edema manifests itself in hypothyroidism First of all, it is a thyroid gland pathology with a failure of its function – hypothyroidism. It can be of different origins: autoimmune, postoperative, as a result of iodine deficiency in food, etc., but regardless of the cause, the thyroid gland produces little hormones.One of the manifestations of hypothyroidism is dense edema – myxedema. Myxedema is most noticeable on the face, but it spreads to the entire body. In addition to edema, there are other symptoms: slowness, drowsiness, memory loss, chilliness, decreased heart rate, menstrual irregularities, decreased body temperature, etc. The thyroid gland can be either enlarged or reduced.
Also causes edema.They can appear, in principle, on any part of the body (face, mammary gland, hand), but more often all the same on the lower extremities (or on one leg). In addition to veins and arteries, a person has lymphatic vessels in the body, through which, in particular, the exchange and outflow of fluid from tissues is carried out. If this outflow is disturbed, the lymph gradually stagnates more and more, the affected part of the body increases significantly in volume, its contours are deformed, and mobility is impeded. The edema is persistent; it does not go away after rest. An early characteristic symptom of lymphostasis is the inability to fold the skin over the affected area when the edema is still small.
The conditions listed here are not a complete list of those diseases that can cause edema. It is important to remember that edema is just a symptom of an unhealthy organ, and there is no single recipe for curing them. Diseases of the kidneys, liver, heart, thyroid gland, blood vessels are treated in different ways, and even the therapy of the same disease in two different people may differ.
Therefore, if you suddenly develop swelling – do not rely on the advice of “experienced” people – go to the clinic, laboratory and take the simplest set of tests:
• general blood test,
• general urine test,
• biochemistry: total protein, urea , creatinine, ALAT, ASAT, bilirubin, blood sugar, cholesterol;
• Ultrasound of internal organs.
Contact a specialist, he will understand and prescribe the correct treatment. And remember, taking medications on your own can be dangerous. For example, improper use of diuretics for a long time (incorrect dosages, intervals between doses, duration of the course) sometimes leads to irreversible loss of kidney function. Do not risk your health, contact a specialist!
90,000 Swelling of the legs. Causes and treatment.
I think that many people experienced fatigue, pain in the legs, accompanied by edema at the end of a hard day.No matter how perfect the human body is, our rhythm of life, the level of physical and mental stress, lifestyle and nutritional errors can cause malfunctions and the state of tissues and body systems.
Edema can accompany healthy people without becoming a pathology. In this case, most often, the swelling of the lower extremities is the result of a periodic significant excess of fluid intake, wearing tight, uncomfortable shoes, excessive physical activity, a sharp increase in weight gain, and an uncomfortable posture that is forced to remain for a long time.Even an unbalanced, illiterate diet can lead to swelling of the legs. All of the above cases are distinguished by the fact that the edema is irregular, sporadic and, after the cause is eliminated, go away on its own.
However, quite often, swelling in the legs becomes constant companions and begins to cause inconvenience, including aesthetic, or cause pain, reducing the quality of life.
Any more or less regularly occurring swelling of the lower extremities should be treated, as this can signal serious abnormalities in the work of vital organs.Of course, the first step is to visit your doctor to diagnose and find the cause of the swelling. There cannot be a single recipe and standardized treatment method – for each specific case and each individual patient, the doctor – therapist, traumatologist, phlebologist, cardiologist, endocrinologist – will choose an individual approach.
So, the main causes of swelling in the legs:
- Heart failure. Additionally, there is pain in the legs, impaired sensitivity and increased chilliness, chest pain, shortness of breath.
- Varicose veins and venous insufficiency. Edema looks asymmetric, persists constantly, the limb is hot to the touch, pain and visible changes in the venous walls are noted.
- Kidney disease. They are characterized by morning edema, the onset of edema after fluid intake, painful sensations in the lumbar region, frequent urination, pallor of the skin.
- Diseases of the thyroid gland. Edema is localized in the area of the ankles, after pressing on the swollen places, no traces remain.
- Injury. Edema occurs after trauma, accompanied by bruising, pain, sometimes severe, limitation of motor activity.
- Lymphostasis. One leg swells more often, and completely.
Medical Center “Zvezda” carries out the diagnosis of edema of the lower extremities and their treatment. Qualified doctors, an advanced diagnostic base and a caring, attentive attitude to each client are at your service!
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Swelling of the legs: reasons, which doctor to see
Why does edema appear on the legs? The doctors of the “Clinic Expert” Smolensk talk about the reasons for their occurrence and what to do if they have appeared in the framework of the interview-consultation.
Ladenkova Natalya Viktorovna, therapist
– Natalya Viktorovna, in what diseases do the legs swell?
– It can be heart failure in case of heart diseases, diseases of the lymphatic system, varicose veins of the lower extremities, kidney disease (while swelling can appear on the face and both limbs), decompensation in diseases of the hepatobiliary system, various oncological pathologies.We encounter edema on the legs with nutritional deficiencies, in particular, with poor protein nutrition, anemia, when general edema appears.
The cause of edema, including on the legs, can be endocrine pathology: overweight, changes in hormonal levels in women, diseases of the thyroid gland, adrenal glands. In addition, sometimes the reason for the swelling of the legs may be the lifestyle of the patients, and not some pathology. For example, with excessive consumption of a large amount of liquid (tea, coffee, other drinks), salt; long sitting on soft and low chairs, in armchairs; engaging in certain sports – too intense and uncontrolled running, walking, strength and static exercises.
– Which doctor should be consulted with edema of the legs? Which one to start with?
– From a general practitioner or general practitioner. The doctor will conduct an examination, take anamnesis, draw up a plan of diagnostic measures – what exactly needs to be examined and, as they say, in which direction to move. Depending on the diagnosis, the therapist himself can deal with the treatment, or, if necessary, he will refer the patient to a narrow specialist – for example, a gynecologist, cardiologist, vascular surgeon, endocrinologist, oncologist, nephrologist.
You can make an appointment with specialists here
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Vataeva Irina Anatolyevna, cardiologist
– There are two large groups of reasons why the legs swell: physiological and pathological. The first includes a violation of the fluid intake and excessive salt intake, excessive physical activity – for example, walking, jogging.Also on this list: gaining excess weight quickly, wearing “the wrong” shoes or tight clothing, maintaining an uncomfortable posture for a long time.
Now pathological reasons. Among cardiological pathologies, this is, first of all, heart failure.
– Can pain in the heart and swelling of the legs be related?
– Yes, there is such a connection. When the heart muscle – the myocardium – begins to suffer from a lack of oxygen, such pain may indicate the appearance of angina pectoris.They arise, as a rule, paroxysmal, localized behind the sternum, can spread to the left shoulder, neck. Pain in the region of the heart often precedes the appearance of edema of the legs, or appears with them. That is, one should focus more on coronary heart disease, and edema is considered as a complication, as one of the symptoms of this disease.
More information about coronary heart disease can be found in our article
The heart loses its ability to pump the entire volume of incoming blood: first, it begins to accumulate in large vessels going to the heart, then the left side of the heart is deficient, and the right ones are gradually connected.As a result, the pressure in the inferior and superior vena cava rises. In general, this is called stagnation in the systemic circulation. Under the influence of gravity, blood accumulates in the lower extremities, and we observe cardiac edema of the legs.
The cardiac output also decreases, which contributes to the stagnation of venous blood. The filtration rate in the kidneys decreases due to vasoconstriction, including the vessels of the kidneys, urine becomes less, and more fluid accumulates in the body.
Lead to heart failure: ischemic heart disease, arterial hypertension, various types of cardiomyopathy, rheumatic heart disease, congenital malformations, arrhythmia, pericarditis, the so-called “pulmonary heart” – when pulmonary embolism occurs, or this type of pathology can lead to long-term chronic lung diseases due to increased pressure in their vessels.
– Irina Anatolyevna, is there a connection between leg edema and shortness of breath?
– Shortness of breath is one of the leading symptoms of heart failure. The pumping function of the heart is disturbed not only in the large, but also in the small circle, the pulmonary vessels overflow with liquid, gas exchange and, accordingly, respiration are disrupted. And in case of heart failure, as I said, swelling of the legs appears. With their appearance, shortness of breath increases, a person does not have enough air even with minor physical exertion.
Minchenkova Ekaterina Aleksandrovna, obstetrician-gynecologist
– Many people ask: “Why do legs swell during pregnancy”? The first reason is the insufficient daily amount of water consumed. Someone thinks that the tea, coffee, juices they drink are enough. No, this is not taken into account, you need to drink one and a half to two liters of pure water per day. In the event of a deficiency, the body begins to store water, which means that the expectant mother gets what everyone wants to avoid: edema begins.In addition, do not forget about the risk of dehydration, especially in cases where the pregnancy proceeds in the heat.
Now about nutrition. Excessive consumption of salty foods, all kinds of chips, fast-digesting carbohydrates leads to the appearance of edema.
The third reason: kidney pathology – when they do not cope with the elimination of fluid from the body.
There is also such a pathology, it is sometimes called the “disease of pregnant women” – preeclampsia. It is accompanied by an increase in blood pressure, the appearance of protein in the urine, and, in particular, swelling of the legs.
During the normal course of pregnancy in women, hormones naturally change. At the same time, the content of the hormone progesterone in the body of the expectant mother significantly increases. This hormone can cause fluid retention and accumulation, which also contributes to the appearance of edema.
And one more reason. By the end of gestation, the uterus is already noticeably enlarged, it squeezes the vessels somewhat, and the outflow of venous blood and lymph from the lower extremities worsens – this can also lead to edema.
– Ekaterina Alexandrovna, is it possible to avoid the appearance of edema of the legs during pregnancy?
– In recent years, after numerous studies, it has been proven that 80% of pregnant women have physiological edema that cannot be prevented in any way, but this allows them to safely carry on and give birth to healthy babies. It happens that a woman does without edema, but in most cases they are still present. And recommendations such as proper nutrition, drinking enough water and moderate physical activity can be considered as prevention of the appearance of edema.
“Despite the fact that pregnancy is a physiological condition, and in the days of our grandmothers, a woman did not go to the doctor as often as now, the diseases associated with it were encountered in the past.” Quote from the material “How to Prepare for Pregnancy”
Asnin Efim Semenovich, vascular surgeon
– Light swelling is not always a sign of some kind of disease. Swelling can appear, for example, if you spend a lot of time sitting at a table, motionless.Or you have to stand a lot at work. In such cases, the edema is mild, usually in the lower leg area, and disappears rather quickly after a little warm-up or rest with the legs raised up.
When these symptoms are pronounced and do not go away for a long time, they are most likely associated with some kind of disease. Edema occurs:
– associated with venous insufficiency;
– associated with hormonal disorders;
– the so-called protein-free – with general depletion and a decrease in the protein content in the blood;
– associated with taking medications (including steroid hormones, some heart drugs), hormonal contraceptives.
Want to know more about hormonal contraceptives? Read our article
– Efim Semenovich, from the point of view of a vascular surgeon, what can you say about leg edema?
– The most common cause is varicose veins of the lower extremities, commonly known as varicose veins. In women, it occurs more often than in men, due to physiological characteristics. The blood flow in a person is carried out as follows: blood flows from the legs, enters the abdominal cavity, then into the chest and then to the heart.For example, during pregnancy, the enlarging uterus compresses the venous vessels. Blood stagnates in the abdominal cavity, leg veins dilate, and the venous valves holding back blood flow do not fully work. As a result, blood begins to accumulate in the vessels of the lower extremities.
In men, varicose veins are most often associated with flat feet. Normally, a person’s foot has two arches – longitudinal and transverse, they, together with the lower leg, create a shock absorption effect when walking.All of this together is called a muscle pump, which helps to drive blood from the foot back to the heart. When flat feet appear, this factor stops working, and the superficial veins in the leg expand. Ultimately, if varicose veins are not treated, very serious consequences can occur, up to the appearance of varicose-trophic ulcers, which are extremely difficult to treat.
To avoid the consequences, people with flat feet need to wear special orthopedic insoles that help to turn on the same muscle pump.
More information about flat feet in adults can be found here
Interviewed by Igor Chichinov
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90,000 When edema is “out of control”: anasarca
The appearance of edema on the legs by the end of a long working day is hardly surprising.And even mild swelling in the morning, as a rule, does not attract attention. But, if the swelling becomes more and more noticeable and “spreads” all over the body, there is no need to postpone the examination. In severe cases, anasarca occurs – edema of the skin and subcutaneous tissue, usually combined with the accumulation of fluid in the body cavities. This is a sign of a breakdown of compensatory mechanisms for a number of diseases, most often associated with congestive heart failure.
Edema and kidneys
The most obvious explanation for puffiness that can “come to mind”, of course, is renal impairment.
The reasons for this pathology can be quite a lot – from overloading the kidneys with “work” (a sharp increase in fluid intake) to serious pathologies (glomerulonephritis, damage to renal vessels in diabetes, and others).
In the latter case:
- or the rate of urination is significantly reduced;
- or along with the urine protein is “lost”, which “retains” the fluid in the bloodstream, preventing the latter from “seeping” into the tissue.
Edema, in this case, usually begins with the face, since it is here that the subcutaneous fat is especially loose and “absorbent”.And, as it progresses, they descend to the body and limbs.
And you can check the condition of the kidneys using:
Edema and heart
Edema of cardiac origin is associated with a weakening of the heart to “pump” blood and the formation of pulse pressure. And, in this case, the venous blood “stagnates” in the vessels and, as a result, its liquid part (plasma) seeps into the tissue.
Cardiac edema often begins in the legs, because here the venous blood moves from bottom to top, and more than other locations it needs a “healthy” pumping function of the heart.And a factor contributing to edema at this level is also venous disease.
The cause of heart “weakness” can be damage to the muscular apparatus of the heart or its valves (congenital defects, streptococcal and some other infections). And, without attention, pathology leads to severe breathing disorders and pulmonary edema.
A to detect heart failure, a blood test for natriuretic peptide (BNP) and ultrasound of the organ are shown.
Edema and liver
It may seem strange, but the liver is the “culprit” of edema no less often than other organs.
The fact is that albumin is synthesized in the liver – a protein that, as already noted, acts as a “buffer” for the liquid part of the blood. A decrease in the production of the latter is observed in hepatitis and cirrhosis.
It is possible to suspect a hepatic origin of edema on the basis of anamnestic data (frequent alcohol consumption, past or chronic liver diseases), as well as a characteristic “ascitic” abdomen. When edematous fluid accumulates in the abdominal cavity, and against the background of normal or reduced body weight, only an enlarged abdomen is released.
In this case, the liver should be checked for chronic hepatitis (minimum, a blood test for ALT, AST, direct bilirubin or a complex “Liver examination, basic”) and dystrophic changes (blood test “NESH-Fibrotest”).
True, protein deficiency can also be a consequence of nutritional deficiencies, digestive pathologies that disrupt the absorption of nutrients, or accompany oncological processes (“cancer” depletion).
And the level of albumin and globulins can be estimated using a blood test for protein fractions.
Swelling and thyroid gland
Deficiency of T4 and T3 hormones of the thyroid gland dramatically slows down all types of metabolic processes, and water-salt metabolism is no exception.
The liquid, in this case, accumulates in the subcutaneous fat, giving the impression of “puffiness”.
True, such edema often does not represent a “mortal” danger. But they still serve as a good reason for checking the health of the gland, since they are accompanied by a number of other deviations in a number of systems and organs (heart, carbohydrate and fat metabolism, immunity, and others).
Terrible consequences of edema
Slow progression of untreated edema syndrome may be a sign of deterioration of the patient’s condition in chronic diseases.
The sudden appearance and rapid growth of edema should cause even greater alertness, since it may be a sign of deep vein thrombosis (usually of the limb) or an excessive allergic reaction. If such edema occurs, you should immediately seek help.
90,000 13 reasons why legs swell
More than 100 muscles and 26 bones of our legs work daily, supporting the body weight when walking, running, dancing, jumping.Our activity can tire the legs quite a bit, so it’s no surprise that one of the most common complaints most people have is leg swelling.
But fatigue is not the only cause of edema. Let’s take a look at 13 causes that can also lead to leg swelling.
1 reason. Long sitting or standing (6 hours or more).
People who work on their feet all day often feel pressured by their shoes at the end of the day. This is due to the fact that when standing for a long time, blood circulation in the legs slows down, and they begin to swell.
It is the same with sedentary work or lifestyle. And if at the same time a person often sits, crossing his legs, then this further impairs blood circulation.
As a rule, edema resulting from prolonged standing or sitting is not a signal of health problems. To reduce swelling in this case, it is enough to walk or, at least, sit up straight without crossing your legs.
When working for a long time in a standing position, it is necessary to take a short break every hour to sit down or do a light warm-up.If this is not possible, doctors recommend wearing compression stockings for prevention.
2 reason. Drinking a lot of salt.
The sodium contained in salt retains fluid in the body, disrupting the water balance and causing edema.
The American Heart Association recommends that an adult consume no more than one teaspoon (2-3 grams) of salt per day.
Please note that it is necessary to count not only pure salt, but also salt already contained in prepared food and products.
3 reason. Pregnancy.
Swelling of the legs is a fairly common occurrence during pregnancy, especially from the second trimester. Experts explain this by the fact that with the growth of the child, the pressure on the veins of the small pelvis increases and blood circulation is impaired.
The longer the gestation period, the more severe the swelling can be. As a rule, in this case, there is no reason to worry. However, if your face and hands begin to swell, you need to see a doctor.
The position in which the pregnant woman sleeps is also important. Sleeping on your back leads to constriction of blood vessels. To reduce swelling, you should move as much as possible, sit and stand less. To improve blood circulation, experts recommend raising your legs above the level of your heart, wearing compression garments and applying cold compresses to your feet.
4 reason. Overweight.
In overweight people, swelling of the legs is quite common.With obesity, blood circulation in the legs is disturbed, the outflow of blood and lymph slows down, resulting in edema.
5 reason. Injuries to the lower leg and foot.
In case of sprains and fractures during training, outdoor games with children or running, as well as after leg surgery, foot swelling often occurs. In this case, doctors recommend raising your legs above the level of your heart and applying a cold compress.
6 reason. Premenstrual syndrome (PMS).
During PMS and menstruation, many women experience increased swelling. Swelling of the legs and feet is especially pronounced.
In addition, hormonal changes when taking hormonal contraceptives or hormone replacement therapy can lead to edema. In this case, you need to increase the amount of fluids you drink, limit salt intake, and do exercises that improve blood circulation.
7 reason. Taking medications that cause edema.
When taking drugs to lower blood sugar in diabetics, it is difficult to remove sodium from the body. This can lead to edema.
Also, edema can occur when taking drugs for the treatment of cardiovascular diseases, in particular, when taking direct-acting vasodilators.
Non-steroidal anti-inflammatory drugs (eg, ibuprofen) can cause severe edema in patients with renal or hepatic impairment, as these drugs trap sodium in the body.
It should also be borne in mind that the legs can swell when taking medication and for no apparent reason.
8 reason. Skin infections.
Legs may swell with skin infections. As a rule, such edema is accompanied by redness and hyperthermia of the affected area. People with diabetes and peripheral vascular disease are most at risk for skin infections.
With the deterioration of blood circulation in the upper and lower extremities, any infections worsen faster.Some conditions, such as systemic lupus erythematosus and rheumatoid arthritis, also increase the risk of leg edema.
To prevent infections that can enter the bloodstream through cracks and abrasions on the legs, it is necessary to moisturize the skin of the legs more often.
9 reason. Lymphedema.
In this case, edema occurs as a result of a violation of the movement of lymph through the lymphatic vessels. Most often, lymphedema develops with obesity, cancer or infectious diseases, but it can also be hereditary.
Therefore, if you suspect lymphedema, you should definitely see a doctor. With such a violation, you need to move a lot.
10 reason. The heart is not pumping enough blood.
Swelling of the feet can be a symptom of such a serious pathology as congestive heart failure.
Heart failure does not mean that the heart stops working. In this case, the contractile function of the heart deteriorates and the heart cannot pump enough blood.
If swelling occurs too often in heart failure, sweating and shortness of breath increase, you should immediately consult a doctor.
11 reason. Thrombosis.
With timely diagnosis of deep vein thrombosis, the disease is treatable. However, if the pathology is not detected in time, a thrombus can enter the lungs, block the supply of oxygen and lead to death.
In some cases, thrombosis may be the cause of leg edema.Blood clots are most common in people with a sedentary lifestyle.
The risk of developing thrombosis increases with pregnancy, obesity, cancer, heart or kidney failure, and taking certain medications.
One of the most common symptoms of thrombosis is pain, discomfort and swelling in the back of the lower leg. If you have these signs for no apparent reason, you should immediately consult a doctor.
To prevent thrombosis, you should move a lot, play sports and sit as little as possible.
12 reason. Kidney disease.
The kidneys regulate the balance of fluid in the body, therefore, if their work is disrupted, edema may appear.
Experts explain that when a person suffering from edema raises their legs above the level of the heart, the body receives a signal about excess fluid and gets rid of it.
In case of kidney diseases, difficulties arise with the elimination of excess fluid, therefore, not only the legs, but also the face, hands and other parts of the body can swell.In this case, the doctor prescribes drugs to remove excess fluid.
13 reason. Liver diseases.
With hepatitis or alcohol abuse for a long period of time, cirrhosis of the liver can occur, as a result of which scars form on the liver. These scars obstruct blood flow to the liver.
This increases pressure in the veins that carry blood to the liver. As a result, swelling of the legs and feet appears.
medical unit # 5 Volgodonsk | MSCh No. 5
The first signs of heart disease can be different symptoms: heart pain, weak accelerated pulse, shortness of breath with minor physical exertion, lethargy, bad mood, poor sleep, palpitations, premature fatigue, edema. – shortness of breath with little exercise or at rest, – weakness, low endurance, – palpitations, – dry cough, – periods of rapid and uneven breathing, – choking, constricting chest pain, – dull pain and discomfort in the liver or heart, – swelling of the legs (especially in the evening), – at night, patients try to raise the upper body (by placing pillows), so it is easier for them to breathe, – restless sleep, insomnia, – the weaker the heart, the more swelling of the legs, pain in the chest and back, breathing becomes extremely difficult until the person lies down.
The best prevention of heart disease is a healthy lifestyle.
It is in our power to prevent the disease even before the first symptoms appear. Of course, there are factors that are difficult to deal with: genetic predisposition, gender, age. And yet, even if you are an elderly man and your father had heart problems, you can achieve tremendous health benefits through prevention.
“Three pillars” on which the health of the human cardiovascular system is based: proper nutrition, physical activity and the absence of bad habits, that is, quitting smoking and moderate alcohol consumption.These principles form the concept of “healthy lifestyle”.
What kind of heart diseases are there?
There are many heart diseases. Here are the main ones: arrhythmias, arterial hypertension, arterial hypotension, coronary atherosclerosis. vascular atherosclerosis, myocardial infarction, ischemic heart disease, heart defects, cardiac asthma, heart failure, etc.