Leg swelling: heart or veins?

One question keeps coming up: “My leg swells, is it my heart?” The answer is not one word. The UK’s National Health Service (NHS) describes swelling of the ankles, feet and legs as usually fluid collecting in the tissue and lists many causes for it. Some are harmless and some are not.

The more common causes

The NHS names these: standing or sitting for long periods in one position, salty food, being overweight, pregnancy, varicose veins, thyroid problems and some medicines (including some blood pressure medicines, contraceptive pills, hormone treatments, antidepressants and steroids). Less common causes: an injury, an insect bite, an infection, a kidney, liver or heart problem, and a clot.

If swelling is due to a lot of standing or to salt, it usually eases with lying down and raising the legs. For swelling the NHS recommends: raise the legs, walk gently, wear loose, low-heeled shoes, keep the skin clean and moisturised and avoid standing or sitting for long periods.

Three questions to ask yourself

1. One leg or both?

• Swelling of both legs mostly comes from long periods of standing or sitting, salt, weight, medicines, varicose veins or a heart or kidney problem. If it has not improved after a few days of simple steps, have it seen.
• Swelling of just one leg, especially if sudden and painful, brings a clot to mind. The NHS says a deep vein thrombosis usually affects one leg (both only rarely) and brings throbbing pain in the calf or thigh, redness or darkening of the skin and prominent veins. Have swelling of one leg with no clear cause seen the same day.

2. What makes it better or worse?

The NHS says that in varicose veins the symptoms get worse after standing for a long time and better when the leg is raised. This pattern points towards the veins, but it is not a diagnosis.

3. What else comes with it?

If swelling comes with shortness of breath, especially when lying down or during everyday tasks, with sudden weight gain, severe tiredness or a night-time cough, the NHS lists this among the signs of heart failure. It is not a diagnosis, but you should see a doctor the same day. Sudden or severe shortness of breath means calling 115 (outside Iran, your local emergency number).

The veins

When the valves in the leg veins weaken, blood pools low and the tissue swells. The signs that go with it: heaviness in the leg, itching, darkening and dryness of the skin and sometimes an ulcer. The NHS says a venous ulcer is usually on the inner side of the lower leg, lasts more than two weeks and needs specialist treatment.

The heart

In heart failure the NHS puts swelling of the legs and ankles or abdomen and a bloated feeling together with shortness of breath, weakness, sudden weight gain and a cough. The causes include high blood pressure, coronary artery disease, valves and heart rhythm. If you have such signs along with leg swelling, do not look at the legs alone, and mention the shortness of breath too.

A clot

For deep vein thrombosis the NHS lists the risk factors: age over 60, obesity, smoking, a previous clot, varicose veins, cancer, heart failure, and pills and hormones that contain oestrogen. Temporary factors: a hospital stay or surgery, three or more days of rest, a journey of more than four hours, pregnancy and the six weeks after giving birth, and dehydration.

If swelling and pain in one leg come with shortness of breath or chest pain, the clot may have reached the lung. Call 115 (the emergency number in Iran) and do not drive yourself (NHS). If you are outside Iran, call your local emergency number.

Medicines

Some medicines cause swelling. If swelling appeared after starting or changing a medicine, tell a doctor. Do not stop the medicine yourself.

When not to wait

The NHS treats these as urgent. Have a doctor see it the same day if:

• The swelling is in one leg and has no clear cause such as an injury
• The swelling is severe, painful or sudden
• The swelling comes with redness or warmth, fever or chills
• The face or abdomen is swollen too
• The patient has diabetes

And call 115 (the emergency number in Iran; outside Iran, your local emergency number) if leg swelling comes with shortness of breath, pressure or pain in the chest, coughing up blood, a noticeable racing heart or fainting and feeling very unwell.

If swelling of both legs has not improved over a few days of simple steps or has got worse, or you have heart, kidney or leg vein disease, book an appointment.

What does an examination do?

A doctor takes your history, examines the legs and heart and, depending on the result, may ask for a Doppler of the leg, an ECG or blood tests. That is why the cause cannot be known from the look of the swelling alone.