Pulmonary Hypertension in Children
Sign In Your Feet Could Indicate Heart Failure - What To Look Out For
13:58, 25 Mar 2025Updated 15:06, 25 Mar 2025
Heart failure, a type of cardiovascular disease that happens when the heart can't pump blood around the body due to it becoming too stiff or weak, is believed to affect over a million people in the UK. Each year sees about 200,000 new diagnoses.
The British Heart Foundation reveals that nearly 40 percent of those living with the condition have early stages of heart failure that could've been detected before they fell seriously ill. While chest pain and shortness of breath are common symptoms associated with heart issues, there are less obvious signs that can appear in unexpected places, such as your feet.
READ MORE: Hoover's 'lightest' cordless vacuum 'more effective' than Dyson is £130 off in Spring SaleSwollen feet could be an indicator of heart failure, according to the Mayo Clinic. This medical condition, known as oedema, can also impact the ankles and legs.
"Congestive heart failure causes one or both of the heart's lower chambers to stop pumping blood well," leading to blood backing up in the legs, ankles, and feet, causing oedema. The NHS also lists oedema in the ankles and legs as one of the "most common" signs of heart failure, which may improve in the morning and worsen later in the day.
Oedema caused by heart failure could also result in swelling in the stomach, reports the Express. The Mayo Clinic has warned that: "Congestive heart failure can also cause swelling in the stomach area.
"This condition also can cause fluid to build up in the lungs. Known as pulmonary oedema, this can lead to shortness of breath." If you notice persistent swelling in your ankles, feet, or legs that doesn't subside after a few days or worsens, it's time to ring up your GP.
But don't jump to conclusions – the swelling isn't a surefire sign of heart failure; it could be down to something as simple as a sprain or an insect bite.
Oedema, the medical term for swelling, might also occur if you've been parked in one spot for too long, if you're carrying extra weight, expecting a baby, or if you're on certain meds like steroids or antidepressants.
Heart failure doesn't come with a one-size-fits-all set of symptoms – they vary from person to person and can either hit you like a ton of bricks or creep up slowly over weeks or months.
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The more common signs include:
Other symptoms are:
What Is Congestive Heart Failure?
Imagine experiencing shortness of breath during everyday activities, like walking to the kitchen to make a sandwich.
Your legs are swelling.
Then, you notice you've had to start propping yourself upright with pillows to sleep at night.
These symptoms on their own can be concerning, but then you get the diagnosis: congestive heart failure.
Those can be scary words to hear. However, most people will develop some form of heart failure as they get older.
But getting on board with being healthy at a young age and understanding the signs of heart failure can pay off down the road.
Here, University of Michigan Health Frankel Cardiovascular Center cardiologist and advanced heart failure specialist Abbas Bitar, M.D., tells you what you need to know.
What is congestive heart failure?
Bitar: The American Heart Association defines heart failure as a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood.
Simply, heart failure is a condition where the heart doesn't pump blood as well as it should.
This happens when the heart's structure or function is damaged, making it harder to fill with blood or push it out to the body.
Congestive refers to fluid buildup in organs which results in symptoms such as shortness of breath and swelling in the legs, ankles or feet, among others.
Heart failure is a broad condition, and patients can have vastly different experiences.
How is congestive heart failure measured?
Bitar: There are multiple ways to measure or classify heart failure.
To start, left ventricular ejection fraction, which is the percentage of blood the left ventricle pumps out with each beat, is most commonly used to classify patients into one of three categories:
Ejection fraction provides vital insight into the strength and function of the heart.
The American College of Cardiology and American Heart Association also determined four main stages of heart failure:
It's important to remember that heart failure is a clinical diagnosis, so it relies on a patient's history, a physical examination and an imaging component to fulfill a clinical suspicion of heart failure.
Finally, there are also four classes identified by the AHA to monitor symptoms and clinical course:
For the most part, stages don't change but classes can vary based on the individual clinical course.
What are the signs of congestive heart failure?
Bitar: The most common symptoms are:
In clinic, we often ask patients how many pillows they use to prop up their heads at night.
Many are surprised by this question, but it helps us assess fluid levels in the body.
The human body functions similarly to a bottle containing liquid. When a bottle with a small amount of fluid is tipped on its side, the liquid remains at the bottom and doesn't reach the top.
However, if the bottle contains a large amount of fluid, the liquid rises to the top. In the human body, excess fluid can accumulate in the lungs, leading to breathing difficulties.
Some patients may also have an irregular heartbeat or chest pain.
These aren't typical heart failure symptoms but result from the main issue.
For example. When excess fluid builds up, it increases pressure in the heart, which can lead to chest pain similar to angina.
What causes congestive heart failure?
Bitar: The most common causes of heart failure are coronary artery disease and hypertension, or high blood pressure.
There are other metabolic causes too, such as thyroid issues, that can affect the heart muscle.
Ultimately, there are two components which can heighten your chances of heart failure:
Age is also a factor: More than 20% of Americans over the age of 40 have some form of heart failure and over 80% of people diagnosed with heart failure are aged 65 years or older.
How long can you live with congestive heart failure?
Bitar: There is no unifying answer for how long someone can live with heart failure.
How well someone responds to treatment and the cause of their heart failure will play a role in their prognosis.
Statistically, patients with advanced heart failure who continue to experience Class 3 or 4 symptoms despite treatment have poor survival rates.
Their risk of mortality can be as high as 50% within one year.
On the other hand, those who respond well to treatment and are not limited with heart failure symptoms can experience survival rates in line with those that do not have heart failure at all.
So, it's a pretty wide spectrum.
How do you treat congestive heart failure?
Bitar: Treatment often starts with managing blood pressure and reducing the congestion that may cause swelling or shortness of breath.
Patients with symptoms of fluid buildup are put on a diuretic, or "water pill", to remove excess fluid from the body and prevent symptoms.
The main classes of medicines are:
Each has been shown to reduce the risk of dying and being hospitalized due to heart failure from anywhere between 15-20%.
None of these medications are risk free, and your health care provider will work with you to manage any side effects, such as sodium retention.
For the smaller subset of patients with advanced heart failure and refractory symptoms, treatments go beyond medication.
Around 10-15% of patients with more advanced symptoms may need other treatments.
This is when you get into heart pumps, like left ventricular assist devices, and heart transplants.
Can heart failure be reversed?
Bitar: It all comes down to the cause of the heart failure.
If someone experiences a heart attack that leads to a scar on their heart muscle, they may not be able to recover from that.
However, if the heart failure is because someone has high blood pressure and then it is controlled by treatment, many of those patients' heart muscles can recover.
The drugs we mentioned in the last question have been shown to reduce the risk of death and hospitalization.
What I tell patients in clinic is, 'You do have heart failure. We can put you on treatment, and then time will tell how you respond.
As a doctor, what do you want patients to know most about congestive heart failure?
Bitar: Heart failure is more common than people realize, but, for most, it's not a terminal condition.
Many patients do well with medical treatment. For those who don't, there are options to help extend and improve their lives.
While there's no cure, identifying and managing risk factors, like high blood pressure and coronary artery disease, early on is crucial.
The key is early diagnosis and intervention, as there's a lot we can do to help to improve patient's quality of life and longevity.
If you care about heart disease, please read studies about a big cause of heart failure, and common blood test could advance heart failure treatment.
For more information about heart health, please see recent studies about a new way to repair human heart, and results showing drinking coffee may help reduce heart failure risk.
Written by Rachel Zeichman.
Source: Michigan Medicine.
Pleural Effusion Linked To Higher Mortality In Pneumonia, CHF, And Cancer
Clinically significant pleural effusion (PE) had an independent association with increased all-cause mortality in US veterans with congestive heart failure (CHF), cancer, and pneumonia, researchers reported in Chest.
The retrospective Veterans Administration Lung Effusion Study (VALUES)
analyzed data from the national Veteran Health Administration database to compare survival in patients hospitalized with or without clinically significant PE who were admitted with a diagnosis of cancer, CHF, or pneumonia.
Eligible participants were hospitalized at VA hospitals in the United States from January 1, 2000, to December 31, 2020, with admitting diagnosis codes (using ICD-9 and -10) of CHF, pneumonia, or malignancy. Participants were categorized as having clinically significant PE (PE group) or not (NO-PE group), and the primary outcome was all-cause mortality.
"
Presence of clinically significant PE should be considered as an independent marker for higher all-cause mortality in patients hospitalized with CHF, cancer, and pneumonia diagnoses.
The final PE group included 34,707 patients, and the final NO-PE cohort included 792,217 participants. Mean ages ranged from 65 years in the pneumonia with effusion group to 73 years in the heart failure with effusion group. The proportion of male participants ranged from 95.3% in the pneumonia with no effusion group to 97.6% in the heart failure with no effusion group.
The median survival time was significantly decreased among patients with CHF with PE vs NO-PE (PE, 1.51 years; 95% CI, 1.40-1.61, vs NO-PE, 3.23 years; 95% CI, 3.21-3.26). The CHF PE group had a median follow-up from hospitalization of 12.7 years (95% CI, 12.0-13.8) compared with 10.2 years (95% CI, 10.1-10.3) for the CHF NO-PE group.
The median survival was significantly reduced for patients with cancer in the PE vs NO-PE group (PE, 1.33 years; 95% CI, 1.27-1.39, vs NO-PE, 2.05 years; 95% CI, 2.02-2.08). The cancer PE group had a median follow-up of 8.4 years (95% CI, 8.2-8.6) vs 12.3 years (95% CI, 12.3-12.4) in the cancer NO-PE group.
Among patients with pneumonia with PE, the median survival time was significantly decreased vs the NO-PE cohort (PE, 4.27 years; 95% CI, 3.94, 4.61, vs NO-PE, 5.11 years; 95% CI, 5.06-5.15). The median follow-up in the pneumonia PE group was 15.1 years (95% CI, 14.7-15.5) compared with 12.6 years (95% CI, 12.5-12.6) in the pneumonia NO-PE group.
No substantial differences were observed in adjusted hazard ratios for all-cause mortality in the 3 cohorts. Hospitalized patients with CHF and PE had an increased all-cause mortality vs the NO-PE cohort (unadjusted HR for all-cause mortality,1.55; 95% CI, 1.51-1.60; HR for all-cause mortality adjusted for age, sex, and Charleston index comorbidities, 1.40; 95% CI, 1.36-1.45). A higher all-cause mortality was observed in patients with cancer in the PE vs NO-PE group (unadjusted HR for all-cause mortality, 1.23; 95% CI, 1.21-1.25; HR for all-cause mortality adjusted for age, sex, and comorbidities, 1.15; 95% CI, 1.13-1.17). The findings were comparable for pneumonia in the PE vs NO-PE cohorts (unadjusted HR for all-cause mortality, 1.07; 95% CI, 1.03-1.10; HR for all-cause mortality adjusted for age, sex, and comorbidities, 1.30; 95% CI, 1.26-1.34).
Among several limitations, significant PEs were assumed to be caused by the admitting diagnoses, and codes were used to identify study patients. Also, participants were from the VA cohort, which was predominantly male.
"Presence of clinically significant PE should be considered as an independent marker for higher all-cause mortality in patients hospitalized with CHF, cancer, and pneumonia diagnoses," the investigators stated.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
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