It’s the end of the day and your feet are swollen again.  You’ve been standing on them all day and you ask yourself, is this normal?  The answer is, yes, it can be.  Swollen legs in older adults is quite common and often benign.  There is a condition called dependent edema, which is the result of gravity pulling fluid down to your legs and feet and, with aging, your body becomes less effective at returning that fluid back to your heart.  In these cases, resting and elevating your legs is the only necessary treatment and nothing further is required.  However, what do you do when elevating your legs doesn’t resolve the swelling?  What if it’s still there in the morning?  That could be a sign of something more.  It’s especially worrisome if you also have shortness of breath, particularly after walking up the stairs or a slight hill or, oddly enough, when you are laying flat.  If you need several pillows to prop you up so you can breathe comfortably and sleep at night, there may be something there going on.  Other worrying signs can include chest pain or a chronic cough, especially one with clear and frothy spit.

If these sound like symptoms you deal with,  you should bring them to the attention of your doctor.  These and other signs are worrisome because they might indicate a condition called congestive heart failure.  Heart failure means your heart is no longer pumping well enough to efficiently circulate blood around the body.  It is a disease that affects nearly 6 million Americans and, unfortunately,  about half of all patients diagnosed with heart failure die within 5 years of diagnosis.  Early diagnosis may help, so it is important that everyone be aware of risk factors like diabetes, high blood pressure, or other forms of heart disease.  Contributing lifestyle factors include alcohol abuse, cigarette smoking, sedentary lifestyle and obesity.  As you may have noticed, all these factors can be controlled or completely circumvented.

Heart failure is diagnosed with a physical exam, some bloodwork, and a chest X-ray.  Your doctor may also recommend an EKG if this is the first time you’ve had any heart concerns.  Heart failure is confirmed by echocardiogram, which is an ultrasound of the heart that gives a 3-dimensional picture of the heart and shows its efficiency at filling and emptying.  This exam may also uncover some underlying issues including valve disease and anatomical abnormalities.

So what can you expect if you get this diagnosis?  Frequent observation and a trip to the cardiologist for sure, but medical management is the gold standard.  Diuretics, medications that increase the amount of salt and water your kidneys remove, can help balance the fluid load in your body.  This means no more shortness of breath or cough and fit will help with that swelling in your legs.  Other medications are available that improve the prognosis and lessen the condition’s impact on your life.  The important thing is, what do you do right now?  First, be aware.  Know thyself.  If you have symptoms, see your primary care physician and, very importantly, adjust those lifestyle factors that pose a threat to your life.