Swelling of cardiac origin appears in the morning or evening

A special place is occupied by edema. which are observed at heart failure. The most common cause of their formation are changes in hydrostatic pressure associated with left-handed decompensation in the presence of a defect, which leads to a limitation of the minute volume of the heart.

These edemas of a stagnant nature appear inarea of ​​the ankles. With the first degree of decompensation, these swelling appear during prolonged movement or standing. Therefore, they are observed during the day, and in the morning after sleep disappear.

With decompensation of the second degree, edema disappears after a longer bed rest. With decompensation of the third degree edema Do not disappear after prolonged lying, but even more.

Tracing edema in this direction makes it possible not only to identify their stagnant nature, but also to assess degree of heart failure. To differentiate these edema from edemaof other origin is important, apart from their location, the establishment of an enlarged liver and changes in the state of the heart: extended boundaries, organic noises, etc., which characterize the heart defect. Often formed and ascites.

Similar edema, however, may appear withmyocarditis, in which there are also other signs of muscular heart failure: dull tones, arrhythmia, etc. Despite accelerated cardiac activity, the reduced shock volume of blood leads to venous stasis in the pulmonary veins (dyspnea, cough), and in addition to the increase in the liver , ascites and swelling in the ankles. Less often, such edema appears with exudative or adhesive pericardial. In such cases, in addition to changing the boundaries of the heart andlistening to deaf tones, falling into the heart area with systole or filling the cardiac-diaphragmatic angle with exudate may be observed and the expansion of the cervical veins, swelling of the face, and sometimes cyanosis and a paradoxical pulse.

When differentiating edema of cardiac origin You must always think about cor pulmonale. in which the expansion of the right heart and the onset of decompensation are the consequence of an acute infiltrative process in the lungscor pulmonale acutum ), or chronic interstitial inflammation, which causes an encumbrance of the right heart (cor pulmonale chronicum ). The latter disease is more common in older children, because it develops slowly, after a long illness with gradually increasing pressure and a small circulation, cyanosis and shortness of breath followed by hypertrophy and dilatation of the right ventricle.

And cases of deep-seated right heart failure The edema increases more and more, it grows and can be generalized, passing from the lower extremities to the top. In lying patients, it can be sharper than anything expressed in the sacral region.

The main reason for education hemodynamic edema is a decrease in pressure in the arteriala system that leads to stagnation and restriction of filtration through the kidneys with sodium retention. In addition, the passage of fluid from the intravascular to the extravascular space causes a decrease in the volume of the circulating mass, an increase of aldosterone production with a secondary retention of sodium and water.