MULTIFACTORIAL ETIOLOGY OF LOWER LIMB EDEMA IN ELDERLY PATIENT WITH HEART FAILURE. CASE REPORT

  • Adina Carmen ILIE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ramona STEFANIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Mihaela HANDARIC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca Iulia PASLARU “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

MULTIFACTORIAL ETIOLOGY OF LOWER LIMB EDEMA IN ELDERLY PATIENT WITH HEART FAILURE (Abstract): Aging population and increasing life expectancy has led to an exponential increase in the incidence of heart failure. In the elderly patient with heart failure lower limb edema is most commonly considered in the context of decompensated heart disease, causes such as malnutrition, kidney and liver disease or secondary drug effects being rarer. We report two cases of edema of noncardiac origin. In the first case, kidney damage was identified, edema resulting from hypoproteinemia and proteinuria, and in the second case it had an iatrogenic cause, namely the adverse effect of dihydropyridine calcium channel blocker. In the latter case, investigations centered on the assessment of body composition revealed the tendency to dehydration vs. hyperhydration, which led to a different therapeutic approach compared to the general tendency to administer per primam a diuretic treatment. The elderly patient with comorbidities that associate heart failure and lower limb edema requires careful investigations of the possible alternative causes.

Author Biographies

Adina Carmen ILIE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)

Ramona STEFANIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)

Mihaela HANDARIC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)

Anca Iulia PASLARU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)

References

1. Thaler HW, Wirnsberger G, Piennaar S. Bilateral leg edema in the eldery. Clinical considerations and treatment options. Europ Geriatr Med 2010; 1: 353-357.
2. Thaler HW, Pienaar S, Wirnsberger G, Roller-Wirnsberger RE. Bilateral leg edema in an older woman. Zeitschrift fur Gerontol Geriatr 2013, 1-3.
3. Clark A, Clelanj J. Causes and treatment of oedema in patients with heart failure. Nature 2013; 10: 156-170.
4. Scholler DA, Achilles A, Manekas D et al. Segmental Bioimpedance for Measuring Amlodipine-Induced Pedal Edema: A Placebo-Controlled Study. Clin Therap 2012; 34(3): 580-592.
5. Alexa ID, Pancu AG, Moroşanu AI et al. The impact of self-medication with NSAIDS/ analgesics in a North-Eastern region of Romania. Farmacia 2014; 62(6): 1164-1170.
6. Samala RV, Navas V, Saluke E. Heart failure in frail, older patients: We can do MORE. Cleveland Clin J Med 2011; 78(12): 837-845.
7. De Freitas EV, Batlouni M, Gamarsky R. Heart failure in the eldery. J Geriatr Cardiol 2012; 9(2): 101-107.
8. Ely JW, Osheroff JA, Chambliss LM. Approach to Leg Edema of Unclear Etiology. J Amer Board Fam Med 2006; 19(2):148-160.
9. Pîslaru AI, Ilie AC, Pancu AG, Sandu IA, Alexa ID. Detection and prevention of frailty in inde-pendently living pre-elderly and elderly in Northeastern Romania. Med Surg J-Rev Med Chir Soc Med Nat Iaşi 2016; 120(4): 909-914.
10. Crăcană IM, Ștefăniu R, Mocanu V, Alexa ID. New developments in the approach and diagnosis of sarcopenia. Rev Med Chir Soc Med Nat Iasi 2016; 120(3): 491-495.
11. Hitoshi Y, Hitoshi S, Hiroshi S. Renal disease in the eldery and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR). Clin Experim Nephrol 2012; 16: 903-920.
12. Lazzarini V, Mentz RJ, Fiuzat M, et al. Heart failure in elderly patients: distinctive features and unre-solved issues. Europ J Heart Fail 2013; 15: 717-723.
13. Richard JG. An Update on Glomerular Disease in the Eldery. Clin Geriatr Med 2013; 29: 579-591.
14. Scholler DA, Achilles A, Manekas D, et al. Segmental Bioimpedance for Measuring Amlodipine-Induced Pedal Edema: A Placebo-Controlled Study. Clin Therap 2012; 34(3): 580-592.
15. Fukazawa R, Koyama S, Kanetaka H, et al. Leg edema detected on comprehensive geriatric assessment for eldery outpatients and its associated risk factors. Nihon Ronen Igakkai Zasshi. 2013; 50(3): 384-391.
Published
2018-10-03
Section
INTERNAL MEDICINE - PEDIATRICS