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What causes edema in thighs with history of valve replacement?

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Posted on Mon, 1 Jun 2015
Question: I am a 78 yr old woman and 5 ft 4. My weight is 250. My thighs are swollen about 2 times larger. I have been wearing knee high compression stockings and was diagnosed with water retention. I have had a replacement valve put in my heart. My feet are also swollen. All this seems to get worse when I am walking.
Could this have anything to do with lymph node problems. My chiropractor said I should drink a gallon of water every day and get a lymph node massage every week, but it doesnt seem to help.
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Answered by Dr. Muhammad Sareer Khalil (2 hours later)
Brief Answer:
would not recommend excess water in take, needs further evaluation

Detailed Answer:
Hello and Welcome

I appreciate your concern

Taking into account the history of valve replacement, the edema and lower limb swelling is most likely related to a poor venous return to the right atrium and ventricle. Though this cause would be tentative at this moment , other causes must not be ignored and should be worked up.
Doppler Ultrasound of the lower limbs is a must to rule out any thrombosis and to determine patency of vessels of the lower limbs. Echocardiogram should be done to know your ejection fraction and to look for any systolic or diastolic dysfunction. Blood pressure measurements should be determined and diuretics should be added to your medication accordingly. Electrolytes should also be monitored at regular intervals when therapy is initiated. I would disagree with your Chiropractor and advise against drinking a gallon of water. In fact, moderate water and salt restriction would be the way to go initially, if indeed its water retention or fluid overload. Lymph node involvement occurs in lymphedema, commonly associated with malignancies, trauma, infections, surgical removal of the nodes draining the area all of which can hinder/block the lymph drainage. Diuretics in this case can wont be a good idea as it could lead to fibrosis and further compromise of the lymphatic drainage system. Physical therapy, compression stockings, limb elevation , skin care should be continued for now as part of general care involving the lower limbs swelling.

Wishing you best of health

Thanks

Please consult your doctor before deciding on any further course of action.

Dr. M.S. Khalil
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Muhammad Sareer Khalil

General & Family Physician

Practicing since :2012

Answered : 2907 Questions

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What causes edema in thighs with history of valve replacement?

Brief Answer: would not recommend excess water in take, needs further evaluation Detailed Answer: Hello and Welcome I appreciate your concern Taking into account the history of valve replacement, the edema and lower limb swelling is most likely related to a poor venous return to the right atrium and ventricle. Though this cause would be tentative at this moment , other causes must not be ignored and should be worked up. Doppler Ultrasound of the lower limbs is a must to rule out any thrombosis and to determine patency of vessels of the lower limbs. Echocardiogram should be done to know your ejection fraction and to look for any systolic or diastolic dysfunction. Blood pressure measurements should be determined and diuretics should be added to your medication accordingly. Electrolytes should also be monitored at regular intervals when therapy is initiated. I would disagree with your Chiropractor and advise against drinking a gallon of water. In fact, moderate water and salt restriction would be the way to go initially, if indeed its water retention or fluid overload. Lymph node involvement occurs in lymphedema, commonly associated with malignancies, trauma, infections, surgical removal of the nodes draining the area all of which can hinder/block the lymph drainage. Diuretics in this case can wont be a good idea as it could lead to fibrosis and further compromise of the lymphatic drainage system. Physical therapy, compression stockings, limb elevation , skin care should be continued for now as part of general care involving the lower limbs swelling. Wishing you best of health Thanks Please consult your doctor before deciding on any further course of action. Dr. M.S. Khalil