If you're over 60 and your legs are painful and swollen, chances are it's not related to a heart condition. A more likely explanation is that it's linked to reduced blood flow through the veins in your legs, said an HonorHealth interventional cardiologist.
"What happens over time is deterioration of valves in our veins as we age," said Mayurkumar Bhakta, MD, an interventional cardiologist at HonorHealth. "This causes a decrease in blood flow back to the heart. So blood begins to pool in the legs instead of circulating well, and this can cause swelling. The most common cause of leg swelling in older adults is what we call venous insufficiency." The second most common cause of leg swelling, he said, is a reaction to certain medications. "Leg swelling is connected to heart problems typically about 10 to 15% of the time."
In those instances, Dr. Bhakta said, swelling in your legs may be accompanied by:
- Shortness of breath
- Chest pains
- Abnormal heart rhythms
- Swelling in other areas, such as the hands or abdomen
Fluid overload indicates heart issue
"When symptoms appear to be more systemic, when the entire body is affected by an overload of fluid volume, those are the kinds of things that may be heart-related," he said.
A condition that's often underdiagnosed even in the face of these symptoms is pulmonary hypertension, or high blood pressure in the lung.
"Essentially the right side of the heart fails because that side isn't built to withstand high blood pressures," said Dr. Bhakta. "The pressures in the lung can climb so high that the right side of the heart can no longer push blood through the lungs' circulatory system."
Other heart problems that can be related to leg swelling include:
- Atrial and ventricular septal defects — holes in the heart that are typically diagnosed at birth
- Certain abnormal heart rhythms
- Issues with heart valves
- Left heart failure: Swollen ankles and legs can be a symptom
Is this an emergency?
Chronic swelling in the legs as a symptom by itself isn't typically a medical emergency. "Call and make an appointment with your primary care physician or cardiologist," said Dr. Bhakta. The biggest concern with vein-related leg swelling is that the signs could also be connected to pulmonary hypertension.
The first thing your primary care physician or cardiologist likely will do is perform an ultrasound examination of your leg veins and an ultrasound of your heart, or an echocardiogram, according to Dr. Bhakta.
The most often recommended non-medical treatment is compression stockings, which compress the veins and ensure that blood continues to flow.
If the exam shows that the valve in a leg vein is deteriorating to a significant degree, your doctor may recommend venous ablation. In this procedure, a medical-grade adhesive seals off the damaged vein.
If your doctor determines that your leg swelling is related to pulmonary hypertension or heart failure (when the heart isn't pumping like it should be), you'll probably undergo additional tests to determine the best treatment. Treatments for both pulmonary hypertension and heart failure include medications and surgery.
Leg pain and weakness
If you're experiencing pain or weakness in your legs and have difficulty walking, you may have peripheral vascular disease. Other PVD symptoms include:
- Numbness in your legs
- A sense of cold in the calf or foot, especially compared to the other side
- A change in the color of your legs
- Sores that won't heal on your feet or legs
- If you're experiencing these signs of PVD, see your doctor
Leg swelling as a single symptom that lasts more than a few days requires an office visit with a primary care physician or cardiologist, Dr. Bhakta emphasized. There's about an 85% chance that leg swelling is related to chronic venous insufficiency or side effects from medications, such as calcium channel blockers or corticosteroids (used to treat high blood pressure). But you’ll need a healthcare provider's direction to determine the cause.
If leg swelling is accompanied by shortness of breath or chest pain, go to the ER.