Diffuse edema of lower extremities

Introduction Diffuse edema of the lower extremities means that the edema begins first from the lower extremities and is diffuse. It is caused by various causes of heart disease, and edema occurs when heart failure occurs. The interstitial fluid of the human body is constantly exchanged and updated, and the amount of fluid between tissues is relatively constant. The constant maintenance of fluid volume between tissues depends on the balance of fluid exchange inside and outside the blood vessels and the balance of fluid exchange between the body and the outside. If these two balances are destroyed, it may lead to excessive accumulation of body fluids in the interstitial space or body cavity, causing edema.

Cause

Heart disease caused by various causes, edema occurs when heart failure occurs.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) angiography

Chronic heart failure

Basic cause:

1. Primary myocardial damage (including: 1. ischemic myocardial damage; 2. myocarditis and cardiomyopathy; 3. myocardial metabolic disorders);

2. The heart is overloaded (1. The pressure load is too heavy; 2. The capacity load is too heavy).

Clinical manifestation

(1) Left heart failure

The most common clinical, mainly manifested as pulmonary venous congestion and decreased cardiac output.

Symptoms: difficulty breathing, cough, cough and hemoptysis, fatigue, exertion, dizziness, palpitations, oliguria and impaired kidney function.

Signs: Both lungs smell and wet sounds. As the condition worsens, the heart of the whole lung can be enlarged, the heart rate increases, the apical area can be heard and the diastolic period runs, and the second heart sound of the pulmonary valve area is hyperthyroidism.

(two) right heart failure

Simple right heart failure is rare, mainly manifested as systemic venous congestion.

Symptoms: Gastrointestinal and hepatic congestion, difficulty breathing

Signs: Edema is a typical sign of right heart failure first occurs in the sagging area of the body, jugular vein sign, hepatomegaly and tenderness, cardiac signs, right ventricular and/or right atrial hypertrophy can be heard and right ventricular diastolic gallop.

(three) heart failure

At the same time, it has clinical manifestations of left and right heart failure.

Acute heart failure

Basic cause:

1. Acute diffuse myocardial damage: common in acute extensive myocardial infarction, acute myocarditis and other causes myocardial contraction weakness, cardiac output decreased sharply.

2. Increased acute cardiac afterload: common in hypertensive crisis, severe valvular stenosis, ventricular outflow obstruction.

3. Increased acute cardiac preload: common in acute myocardial infarction or infective endocarditis caused by valvular damage, valvular rupture caused by valvular acute reflux, and intravenous transfusion, infusion too much or too fast.

4. Arrhythmia: It is common on the basis of the original heart disease to produce rapid (heart rate > 180 beats / min) or slow (heart rate < 35 beats / min) arrhythmia.

Clinical manifestation

Acute left heart failure is mainly characterized by sudden severe breathing difficulties, respiratory rate of 30 to 40 beats / min, sitting breathing, gray complexion, cyanosis, extreme irritability, sweating, and frequent coughing, coughing up a lot of white or Pink foamy sputum. Very severe people can be confused by the lack of oxygen in the brain.

Differential diagnosis

Diffuse edema of the lower extremities requires identification of different edema symptoms from the following.

(1) Cardiac edema: rheumatism, hypertension, syphilis and other causes and congestive heart failure constrictive pericarditis caused by various diseases such as valves and myocardium.

(2) Nephrogenic edema: acute glomerulonephritis chronic glomerulonephritis nephrotic syndrome pyelonephritis renal failure renal atherosclerosis renal tubular lesions.

(3) Hepatogenic edema: liver cirrhosis, liver necrosis, liver cancer, acute hepatitis, etc.

(4) Malnutrition edema:

1 Insufficient intake of primary food: hunger caused by war or other causes (such as severe famine);

2 secondary dystrophic edema is seen in a variety of pathological conditions. Such as secondary food intake (acne loss due to severe anorexia dysentery, gastrointestinal disorders, pregnancy vomiting, neurological disorders, oral disorders, etc.) Digestive dysfunction (insufficient digestive juice, intestinal hyperstimulation, reduced absorption area, etc.) excretion or Excessive loss (large area burns and exudation, acute or chronic blood loss, proteinuria, etc.) and impaired protein synthesis, severe diffuse liver disease.

(5) Edema caused by connective tissue disease: common in lupus erythematosus, scleroderma and dermatomyositis.

(6) allergic edema: such as serum disease.

(7) endocrine edema: Syndrom of inappropriate secretion of ADH SI-ADH, adrenal hyperfunction (Cushing's syndrome aldosterone secretion), hypothyroidism (hypophyseal anterior pituitary dysfunction) Hypothyroidism, thyrotropin-releasing hormone secretion is insufficient), hyperthyroidism, etc.

(8) idiopathic edema: this type of edema is an unexplained or undetermined cause (multiple reasons may be more than one) syndrome, more common in women are often related to the periodicity of menstruation.

(9) Others: anemia edema, toxic edema in pregnancy.

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