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Why does a patient with heart disease retain fluid?




Left-sided heart failure, which is due primarily to a weak left ventricle, usually is caused by coronary artery disease, hypertension, or disease of the heart valves. Typically, when these patients initially come to the doctor they are troubled by shortness of breath with exertion and when lying down at night (orthopnea). These symptoms are due to pulmonary edema that is caused by pooling of the blood in the vessels of the lungs.

In contrast, right-sided heart failure, which often is due to obstructive sleep apnea or chronic lung diseases such as emphysema, initially causes salt retention and edema. Persistent salt retention in these patients, however, may lead to an expanded blood volume in the blood vessels, thereby causing fluid accumulation in the lungs (pulmonary congestion) and shortness of breath.

In patients with heart failure due to weak heart muscle (cardiomyopathy), both the right and left ventricles of the heart are usually affected. These patients, therefore, can initially suffer from swelling both in the lungs (pulmonary edema) and in the legs and feet (peripheral edema). The physician examining a patient who has congestive heart failure with fluid retention looks for certain signs. These include:

  • Pitting edema of the legs and feet
  • Distended neck veins. The distended neck veins reflect the accumulation of blood in the veins that are returning blood to the heart
Medically Reviewed by a Doctor on 4/30/2015

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