Could the Swelling in My Feet Be Related to Heart Disease?

Swelling (edema) in the feet or ankles is something many people experience from time to time. Mild swelling in the feet can develop especially after standing for long periods, in hot weather, or after long trips, and most of the time it does not indicate a serious illness.

However, foot swelling that is persistent, gradually increasing, or accompanied by other symptoms such as shortness of breath may be a sign of an important underlying health problem. One of these causes is heart failure. Still, it should be remembered that not every case of foot swelling means heart disease. Kidney disease, liver disease, venous insufficiency, lymphedema, certain medications, and many other conditions can also cause swelling in the feet.

What Is Edema?

Edema is a condition in which more fluid than normal builds up in the body's tissues. This fluid most often collects:

• In the feet
• In the ankles
• In the legs. In more advanced cases, it may also be seen in the abdomen and, rarely, throughout the whole body.

Why Does Heart Disease Cause Swelling in the Feet?

When the heart cannot pump enough blood to the body, especially when the right side of the heart is affected, blood in the veins begins to back up. As a result:

• Pressure inside the blood vessels increases.
• Fluid leaks out of the blood vessels.
• Due to gravity, fluid collects mostly in the feet and legs.
• For this reason, in people with heart failure, edema in the ankles and legs

may develop.

What Is Swelling Due to Heart Failure Like?

Edema due to heart failure has some typical features:

• It usually appears in both legs at the same time.
• It may increase as the day goes on.
• It is more noticeable in the ankles.
• When pressed with a finger, a dent may remain for a while (pitting edema).
• It may be milder in the morning and more noticeable toward the evening.

As the swelling progresses, it may spread to the calves, knees, and even the abdomen.

Which Symptoms Point More Toward Heart Disease?

If foot swelling is accompanied by the following symptoms, the likelihood of heart failure increases:

• Shortness of breath
• Difficulty climbing stairs
• Getting tired quickly
• Waking up at night short of breath
• Difficulty breathing when lying flat
• Rapid weight gain in recent days
• Palpitations
• Weakness
• Reduced exercise capacity

If these symptoms are present, a cardiology evaluation should not be delayed.

Does Swelling in Both Legs Mean Heart Disease?

No. Swelling in both legs can develop for many different reasons, such as:

• Heart failure
• Kidney disease
• Cirrhosis of the liver
• Venous insufficiency
• Lymphedema
• Certain hormonal disorders
• Excessive salt intake
• Obesity.

For this reason, a diagnosis cannot be made just by looking at the swelling.

What Does Swelling in One Leg Suggest?

If the swelling is in only one leg, conditions such as

• Deep vein thrombosis (a blood clot in a vein)
• Cellulitis (skin infection)
• Lymphedema
• Trauma

• Venous diseases are investigated first.

Swelling that develops suddenly on one side, especially with pain and redness, requires emergency evaluation.

Which Medications Can Cause Foot Swelling?

Some medications can also cause edema. For example:

• Some blood pressure medications
• Medications containing cortisone
• Some painkillers
• Some diabetes medications
• Hormone therapies
• If edema develops due to medications, you should not stop the treatment on your own; you should consult

your doctor.

Which Tests Might the Doctor Order?

To investigate the cause of foot swelling, your doctor may perform the following evaluations:

• Physical examination
• Electrocardiography (ECG)
• Echocardiography (ultrasound of the heart)
• Chest X-ray
• Blood tests
• BNP or NT-proBNP level
• Kidney function tests
• Liver function tests
• Urinalysis
• Ultrasound of the leg veins when needed (Doppler ultrasonography)

Echocardiography and BNP/NT-proBNP tests in particular provide important information when heart failure is suspected.

How Is Foot Swelling Treated?

Treatment depends entirely on the underlying cause. If the edema is due to heart failure, the following may be used:

• Heart failure medications
• Diuretics (water pills) if necessary
• Reducing salt intake
• Regulating fluid intake
• Regular follow-up.

In venous insufficiency, compression stockings and lifestyle changes may be recommended. For this reason, an accurate diagnosis is very important.

What Can You Do to Reduce Foot Swelling?

Whatever the cause of the swelling, the following suggestions may be helpful unless your doctor tells you otherwise:

• Do not stay inactive for long periods.
• Walk regularly.
• Do not eat too much salt.
• If you need to sit for a long time, move your legs from time to time.
• Raise your legs above heart level while resting.
• Maintain your ideal weight.
• Wear compression stockings if your doctor has recommended them.

When Should You Go to the Hospital Urgently?

If you have any of the following symptoms, you should seek medical care without delay:

• Sudden swelling in one leg
• Severe shortness of breath
• Chest pain
• Fainting
• Rapidly increasing widespread edema
• Redness and severe pain in the leg
• Bluish discoloration or coldness

These symptoms may be warning signs of a blood clot, advanced heart failure, or other serious diseases. Does every case of foot swelling mean heart disease? No. Among the most common causes of foot swelling are venous insufficiency, standing for long periods, certain medications, and kidney disease. Does everyone with heart failure get swollen feet? No. Especially in the early stages of the disease, only shortness of breath or getting tired quickly may occur. Edema may appear in more advanced stages. Does salt intake increase foot swelling? Yes. Eating too much salt can increase edema by causing the body to retain water. Limiting salt intake is especially important for patients with heart failure. If I have foot swelling, should I take a diuretic? No. Diuretics should only be used on a doctor's recommendation. This is because not every case of edema has the same cause, and unnecessary use can lead to serious side effects. , Conclusion:

• Swelling in the feet or ankles can be one of the important
• signs of heart failure, but it is not the only cause. Edema that develops in both legs at once,
• gradually increases, and is accompanied by symptoms such as shortness of breath, getting tired quickly, or shortness of breath at night
• should be evaluated for heart disease. On the other
• hand, kidney disease, venous insufficiency, liver disease, certain medications,
• and many other conditions can also cause foot swelling. For this reason, persistent or
• unexplained foot swelling should not be ignored, and you should seek medical care
• to determine its cause

References:

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Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure:

• A Report of the American College of Cardiology/American Heart Association Joint Committee

on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. McDonagh TA et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-3639. Largeau B, et al. Drug-induced peripheral oedema: An aetiology-based review. Br J Clin Pharmacol. 2021 Aug;87(8):3043-3055. Amandeep Goyal; Baltej Singh; Muriam Afzal. Peripheral Edema. https://www.ncbi.nlm.nih.gov/books/NBK554452/ Chadwick SE. The use of leg elevation in the treatment of chronic peripheral oedema. Br J Community Nurs. 2022 Oct 1;27(Sup10):S28-S32. Cho S, Atwood JE. Peripheral edema. Am J Med. 2002 Nov;113(7):580-6. Koirala A, et al. Etiology and Management of Edema: A Review. Adv Kidney Dis Health. 2023 Mar;30(2):110-123. Hansen B. Fluid Overload. Front Vet Sci. 2021 Jun 29;8:668688.

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