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Suggest Treatment For Severe Swelling In Legs
Question: I have severe swelling in both legs - starting about mid thigh and continuing to both feet. DVT has been ruled out and the adema is unaffected by Lasix at 60mg a day. Thoughts?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
Regarding your concern, I would like to explain that, as no any local responsible cause for your severe legs swelling has been revealed, the most likely reason of your clinical symptomatology seems to be an important right heart failure.
The long-standing pulmonary hypertension almost unequivocally leads to some degree of right heart failure with the subsequent systemic venous congestion (limbs edema, liver enlargement, jugular veins distension).
Now, returning to your actual clinical scenario, the fact your legs swelling are persistent, raises some clue points to consider:
- the daily dose of Lasix may not be sufficient regarding your clinical status (degree of pulmonary hypertension, right ventricle function). In such case, a review of your actual therapy need to be done and a new treatment scheme implemented.
- any concomitant abnormality such as a decreased kidney function, abnormally decreased blood proteins level may be responsible for this sub-optimal diuretics result.
Coming to this point, I would recommend to perform some medical tests:
- cardiac ultrasound,
- complete blood count,
- renal function tests,
- blood electrolytes level,
- blood protein (albumin) level
Also, a daily measure of your urine output and body weight would be a rationale strategy for checking the therapy (diuretics) efficacy.
You need to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
Regarding your concern, I would like to explain that, as no any local responsible cause for your severe legs swelling has been revealed, the most likely reason of your clinical symptomatology seems to be an important right heart failure.
The long-standing pulmonary hypertension almost unequivocally leads to some degree of right heart failure with the subsequent systemic venous congestion (limbs edema, liver enlargement, jugular veins distension).
Now, returning to your actual clinical scenario, the fact your legs swelling are persistent, raises some clue points to consider:
- the daily dose of Lasix may not be sufficient regarding your clinical status (degree of pulmonary hypertension, right ventricle function). In such case, a review of your actual therapy need to be done and a new treatment scheme implemented.
- any concomitant abnormality such as a decreased kidney function, abnormally decreased blood proteins level may be responsible for this sub-optimal diuretics result.
Coming to this point, I would recommend to perform some medical tests:
- cardiac ultrasound,
- complete blood count,
- renal function tests,
- blood electrolytes level,
- blood protein (albumin) level
Also, a daily measure of your urine output and body weight would be a rationale strategy for checking the therapy (diuretics) efficacy.
You need to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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