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Dr. Andrew Rynne

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What causes venous distension around the legs?

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Dr. Prakash H Muddegowda

Geriatrics Specialist

Practicing since :2004

Answered : 2138 Questions

Question
I am a 58 yr. old male, 5'11" about 190 lb - very slim with no fat around the waist. Exercise regukarly and eat very healthily. I have a family history of hypertension and was on list no prix hydrochloric halide in a moderate dose for 15+ ywars. Blood pressure was very well managed typically 115/75 for many years. I swim laps and walk 4 miles 3-4 days a week for exercise. In 2009 I lost my life savings due to a banking fraud (in Switzerland of all places) - after a six month delay, I began to experience large BP swings which resulted in two ER visits and BP spikes of 200/100. 


Doctors wanted to put me on 3 different heart mess but I did a nuclear treadmill stress test and blood flow throughout cardiovascular system was completely normal. I did some reading around and discovered CoEnzymeQ10 and started taking it in a pharmaceutical grade and just doing a lot of walking. At the time my legs felt like lead starting exercise, but would be fine after a half an hour walking. After 4 months on a strong CoEnzymeQ10 I was doing so well I was able to get off the lisinopril/hydrochlorothiazide and I completely normalized my BP. In the following years my BP remained excellent, I lost 40 lbs and am almost at my weight when I was 25 yrs. old.


However, I have been under severe stress the past 5 years however due to employment limitations - because I have a neuromuscular injury in the sub-scapular area of my upper back left side - this is a shrunken muscle right on the rib cage directly behind my heart - right under left shoulder blade. This is an injury I've had for 20 years and is inoperable. It has caused a lot of chronic inflammation in my upper chest - so much so that my chest hair went white at the age of 45. This is by no means a life threatening injury but it is currently about a 30-40% disability with symptoms very similar to ague or fibro myalgia when it rains or the barometer drops.


I use no painkillers or anti inflammatories as I learned years ago they can attack your heart and liver. I use a lot of cardiovascular tonics and natural anti-inflammatories such as Krill oil, serrapeptase, curcumin spice, magnesium, Hawthorne berry, l-arginine and some other supplements - all very safe but no drugs. Diet is excellent, fresh vegetable juice, little red meat, cook only with coconut oil, haven't eaten a dash food meal in 5 yrs. Etc.


Now to the point. In the past 6 months I started noticing sharp stinging pain around my heart muscle,  but it's mild, and only occurs at random intervals completely unrelated to exercise or exertion. I am also experiencing worrisome coronary signs. In the swimming pool (I've been swimming l as for 30 years, I will experience mild palpitations and mild SOB after swimming just a few laps. But on other days after a 3-4 mile walk I can run up stairs as quickly as a 25 yr. Old and feel absolutely fine.


The leaden feeling has been coming back mildly in my lower legs when I set out to walk - but dissipates with exercise. The veins around my ankles feel tender and distended after starting exercise walking and the tenderness persists after exercise also. Six months to a year ago I started feeling very itchy skin around my calves after a working day (I am standing all day at work but otherwise tolerate it quite well). In the last few weeks the stinging pain over the heart is recurring frequently but I also gave some very badly locked up muscles in my left upper back so it could be referred thoracic muscular pain.


I gave also noticed my lower legs felt like they were sweating a bit during the heart stinging episodes. At work on recent days I could feel my BP was rising and felt some coronary mild shortness of breath. Disclosure - I gave very bad oral health at this time as I had receding gums for many years and gave not had a teeth cleaning in 8 yrs. due to the financial setbacks. Otherwise I am in a very good condition for a 58 year old, people often mistake me for 45. 


Symptoms: occasional leaden feet, occasional sweating and or persistent itching around the calves and ankles, occasional mild SOB only when the BP is misbehaving, occasional mild palpitations when I am stressed (not with exercise though!), and now recurring stinging around the heart (never lasts longer than a few seconds). No perceptible swelling or fluid retention around the ankles. I am worried that XXXXXXX nay be early signs of peripheral vascular disease - although my right leg is in fact 1 mm. longer than my left leg and I've walked a lot without any insole compensation. 


The legs feeling like lead, stinging feeling, mild palpitations occasionally, feeling of venous distention around the ankles make me worry that these may be the early signs of peripheral vascular disease. Plaque, or abnormal blood lipids entirely absent from cardiovascular scan five years ago. My left side upper back is very badly locked up with bad chronic inflammation directly behind my heart muscle, and worsens a bit every year. I have managed the inflammation aggressively and successfully with natural supplements for many years - viz. I treated and resolved my own hypertension five years ago after some bad BP episodes - solely with natural supplements and diet.


Any medical professional's guess as to what the issue my be would be much appreciated.
Tue, 12 Aug 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Prakash H Muddegowda 4 hours later
Brief Answer:
Varicose veins and arrhythmia.

Detailed Answer:
Hi,
I am Dr. Prakash HM and I will be answering your query.

After going through you past clinical history and present symptoms, I can give my opinion as follows:


1. Venous distension around the legs - appears to be "Varicose veins" - These are dilatation of veins due to loss of valves in the bigger veins in the legs. Blood stays back in the leg and percolates through the vessel leading to fluid accumulation and damaging the skin. It can be it itchy, stinging (Red black patches can be seen) and ulcers can form in due course due to skin damage.

2. Occasional palpitations could be arrhythmia - possibly condition called as supraventricular tachycardia. or other type of arrhythmia.

3. Lead feeling in the legs, I would not think of peripheral vascular disease at present. As you are not a smoker and your heart was in good condition, the reduced feeling can be attributed to nutritional deficiency of vitamins or minerals along with added Varicose veins.

Investigations and treatment necessary:
Legs: Press over your ankle, if there is any depression, it means fluid collection. If there is no fluid and only prominent veins
a. Doppler study is necessary to confirm the absence of valves in veins and back pressure
b. Once confirmed - Varicose vein compression bandage needs to be put most of the times, to prevent further damage. You can wear the type of bandage looking at how much dilated veins level is there (below knee, above knee, etc).

Heart: Palpitations and shortness of breath:
a. You will require a 24 hr ECG study to confirm it.
b. Once confirmed - anti-arrhythmia medications will be necessary.
C. Sometimes palpitations are the only predictor of cardiovascular disease - an evaluation might be necessary.

For nutritional deficiency - particular vitamin B12 rich diet is essential. If not you can take nutritional supplements of vitamins and minerals.

Get your Blood pressure evaluated and if it is abnormal, it needs to be brought under control as high blood pressure can explain both the symptoms.
You are very fit and I do not think there could be a peripheral vascular disease. Try to get yourself tested and diagnosis confirmed.

Any further queries, happy to help again.
Dr. Prakash HM
Above answer was peer-reviewed by
 
Follow-up: What causes venous distension around the legs? 4 hours later
Dr. Praise I have a follow up question and comments but the Android app. is not permitting me to hit the send button after composing it. I have submitted my response to you in a new query. Please reply to that one so that this conversation is coherent - else it will be routed to another MD who has not read the first part.


Sorry - I tried to submit the follow up question from a XXXXXXX smartphone - with auto-correct problems, hence misspelled your name. Here is the follow up question in case it did not post properly above:

_____________________

Dr. XXXXXXX there is absolutely no evidence of prominent veins in my legs. zero varicose veins in evidence. However you may well be right about blown out valves in the veins. what is the test to check for distended valves? For the arrhythmia question - I have no perceptible arrhythmia - if it's there it us minute. The shortness of breath is only very occasional and very slight. I only really feel it when blood pressure rises sharply which is still very occasional.

I am quite reticent at the idea of taking anti arrhythmia drugs at my very minor stage - I have drastically stepped up my intake if a wide range of arterial anti-oxidants (will list them and they are many and we'll researched for safety - eg. Simple things like grape seed extract, mega doses of vitamin C and CoEnzymeQ10). I am thinking of asking my GP to put me back on lisinopril hydrochlorothiazide which completely stabilized BP for many years.

Please keep in mind that I have **kept my BP normal with no medicine** at all this past five years although I was in the second half of my fifties. So the thought of jumping into anti-arrhythmia drugs wholesale seems like a very pharmaceutically aggressive approach at this early juncture.

I omitted to mention one thing but it is significant. One quite good doctor I consulted privately gave me a whole body thermal scan, spotted the emerging venous condition in my right leg, and also spotted what he said was a malfunctioning pyloric valve, which I have since mostly confirmed as when I am nervous meals pass right through my small intestine and I get diarrhea. BTW I have had an iron gut all my life until the past 3-4 years. No colicky stomach at all and I can eat any amount of spicy food no problem.

The clear corollary symptom is that my small intestine gets swollen with gas as the food passes right through the pyloric before proper intestinal breakdown. I have very minor distress from it BUT there is one very interesting corollary - both intestines are distending moderately - pushing up into the diaphragm and this doctor said the flow of blood from the heart is disrupted by this constant pressure, and that over the years my heart has "learned" to pump blood upward through other arteries.

I have to get more details on this but I can categorically confirm that my colon is acting exactly in line with the pyloric valve dysfunction. With long time passing with this condition, it could begin to stress the heart. When I exercise I don't so much feel that the heart can't take it, but rather the symptoms could well be that the trajectory of blood exiting the heart can't flow freely downward because the diaphragm is pressing upwards. All of this can cause the feeling of congestion.Â

I also want to downplay the amount of SOB I experience - it does NOT come from exertion - it comes only *very slightly*, when my blood pressure is rising sharply and that seems almost always from stress (angiotensin). BP has been very well behaved this past 5 yrs without medicine but I may well be getting to the point where my natural supplements protocol needs some extra help with that. I am very trim with almost no abdominal fat but my lower abdomen is always a bit distended which lends credence to this distended small intestine thesis.

I am very grateful for the guidance you can offer as it will guide me to getting the proper tests to confirm all this. I think you are probably spot on about the veins in the lower legs - but I repeat there is almost zero sign of varicose veins - a few of the principal ones in the right leg are a bit more distended than the 1 MM. shorter left leg. I feel that the single most important thing here would be to test for and confirm that a distended small intestine is pushing up the diaphragm and putting a strain on the normal coursing of blood. That would be a strain on the arteries also!

Belly has been moderately distended for years now while the rest of me is bordering on thin. Thank you for your advice thus far. You are far more engaged in deciphering my symptoms than my HO doctors who are more formula driven Wish you were in San XXXXXXX
 
 
Answered by Dr. Prakash H Muddegowda 1 hour later
Brief Answer:
Get varicose veins diagnosed.

Detailed Answer:
Hi
Thanks for asking the query and glorious words.

Varicose veins can be confirmed by a "color Doppler study".
The most common cause of varicose vein is prolonged standing.
As you are finding skin changes, it will require treatment.
Elastic support compression stockings can be used.

Palpitations are usually seen immediately after exertion or emotional stress. As you are finding palpitation, other than these times, it could be most probably arrhythmia commonly (supra-ventricular tachycardia or SVT).
Most of the times, it is completely harmless or benign.
Treatment for palpitation is instituted when it is associated with lightheadedness or dizziness (which at present you do not have at present)

Judging by the clinical history, I would say your heart and other major organs are in good condition.
If you have high blood pressure now, you can get yourself started on any anti-hypertensive (avoid calcium channel blocker group). If not, continue with your regimen.
Without hypertension, if started, it could cause hypotension, dizziness and other unnecessary complications due to falling.

I do not however agree with small intestine bloating and compressing the vessels or the diaphragm. Bloating is very common and intestine has plenty of space to move around the abdomen. I would agree with your bloated stomach. But I would not agree with you it causing any other symptoms as you are perfectly normal other than possible varicose veins.

Continue your supplements and stay healthy.
Hope it helps.
Any further queries, happy to help again.
Dr. Prakash HM
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