HEART - EDEMA

Edema is a swelling or puffiness of tissue around the ankles, legs, eyes, chest wall, or abdominal wall. The swelling is due to retention of water or lymph fluid in the cells of the tissue. Technically, edema is classified as a sign, rather than a symptom, because it is physically observable. For example, a sign of a broken arm is severe swelling, while the symptom is pain.

Edema is a common sign of heart disease. The site of edema serves as a signal for several different problems with the heart. If the muscle of the right side of the heart is weakened and the pumping quality is diminished, edema may be noted in the abdomen or legs as pressure builds behind the right heart.

Swelling that occurs in the ankles in the evening after standing during the day may indicate that an individual is retaining salt and water, which maybe the result of right-sided heart failure. (If the left side of the heart is weakened, pressure will build in the pulmonary veins, then the lungs, and also lead to dyspnea, but not edema.) This may also be the result of gravity in people who are sedentary; the lack of exercise results in blood being retained in the lower legs and not returning to the heart. Individuals with varicose veins and other abnormalities in the veins of the lower extremities may develop ankle edema as well.

A second major cause of edema is kidney disease, sometimes called nephrotic syndrome. This means the kidney is not getting rid of salt and water adequately and allows fluid to buildup in the body.

Edema may also be caused by liver disease. Albumin, which is made by the liver, is a vital protein in the blood that keeps fluid from escaping from the blood vessels into the surrounding tissues. Liver diseases, such as cirrhosis caused by alcoholism, affect the production of albumin and cause edema.

At times, edema may result from an allergic reaction to substances such as foods, insect venom, or drugs such as the ACE inhibitors, which are used to treat heart failure or high blood pressure. This syndrome is sometimes called angioneurotic edema. It may be characterized by local hives or swelling at the site of a bite or sting, or by a generalized systemic reaction that includes swelling around the eyes and swelling of the tissues of the throat, leading to asphyxiation. Fortunately, this symptom is rare.

Edema also may result secondarily from interference with the lymphatic system. This occurs sometimes in women who have undergone surgery for breast cancer that included removal of the lymph nodes in the axillas or armpits. Similarly, cancer that has spread to the lymphatic system may lead to swelling of the arms or legs.

Edema is nearly always considered abnormal and a potential sign of disease. However, there is probably no cause for concern when edema occurs on a hot day when an individual has consumed a generous amount of water and salty foods. It also is not uncommon for the ankles and feet to swell somewhat during late pregnancy and in travelers who have been sitting for a long period of time.