Pulmonary hypertension and edema
Fact-checked by Pulmonary hypertension (PH) can cause edema, or swelling in the body due to excess fluid, when the condition places increasing strain on the right side of your heart. As the right side of the heart has more difficulty pumping blood through the lungs, blood can back up into the body’s veins, allowing fluid to move into surrounding tissues and accumulate in your legs, ankles, and abdomen. Â
Edema can be a clear sign that PH is affecting how well the right side of your heart pumps blood. Understanding the connection between PH and edema is essential for spotting early warning signs, tracking subtle changes in your body, and protecting your overall cardiovascular health.
Recognizing why fluid retention in PH develops, the symptoms you may notice, and how your care team evaluates and treats swelling can empower you to take proactive steps alongside your medical team to manage your condition effectively.
Symptoms and warning signs of fluid retention
Edema means swelling caused by excess fluid collecting in body tissues. In PH, this often occurs in the parts of your body outside your lungs.
When the right side of your heart is strained, fluid can build up in the lower part of your body. This can cause swelling in your feet, ankles, legs, or abdomen, along with rapid weight gain. You may also notice worsening shortness of breath.
Swelling in the feet, ankles, and legs
One of the most noticeable signs of fluid retention is swelling in the lower parts of the body. For instance, PH can cause leg swelling, as well as:
- puffy or swollen ankles
- feet that appear larger than usual
- tight shoes or socks
- indentations left behind by socks
Abdominal swelling and feeling full quickly
Fluid can also build up in your abdomen, causing swelling, bloating, or a feeling of fullness.
You may notice:
- an increase in the size of your abdomen
- clothing that feels tighter around your waist
- a feeling of fullness after eating only a small amount
You may also notice unintentional weight gain. This is because retained fluid adds weight. Rapid weight gain may sometimes be a sign of fluid retention rather than a change in body fat.
Your healthcare team may recommend checking your weight regularly to help detect changes early. You should consider seeking care urgently if you experience a rapid jump in weight, such as gaining two pounds (about 1 kg) in one day or five pounds (about 2.5 kg) in a week.
Worsening shortness of breath and fatigue
Fluid retention can add to the physical strain already caused by PH.
As fluid buildup worsens, you may also experience:
- increasing shortness of breath
- more fatigue than usual
- greater difficulty exercising or completing daily activities
- chest tightness or discomfort
- difficulty lying flat comfortably
These symptoms do not always mean that fluid retention is the cause. For this reason, new or worsening symptoms are always worth discussing with your PH care team.
Peripheral edema vs. pulmonary edema in PH
PH peripheral edema and pulmonary edema describe fluid buildup in different parts of the body. The table below describes pulmonary edema versus peripheral edema in PH.
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| The differences | Peripheral edema | Pulmonary edema |
|---|---|---|
| Where fluid builds up | Tissues of your extremities, commonly the feet, ankles, and legs | Inside the lungs, including the air sacs |
| Common appearance | Visible swelling or puffiness | Usually causes breathing problems rather than visible swelling |
| Relationship to PH | Can occur when right-sided heart problems cause fluid to back up in the body’s circulation | Is not the typical form of edema associated with right-sided heart failure in PH |
| Possible symptoms | Leg or ankle swelling, or rapid weight gain | Severe shortness of breath and cough |
| Urgency | Should be reported to your healthcare team, particularly if worsening | Can be a medical emergency and requires urgent evaluation |
Peripheral edema in PH is therefore different from fluid buildup inside the lungs.
This distinction is important because you may hear the word edema and assume that all fluid buildup occurs in the lungs.
In PH, swelling is often located in the legs, feet, and abdomen.
Fluid buildup in the lungs, however, can cause severe breathing problems and may have different underlying causes.
When should you seek urgent medical help?
Sudden or severe changes in breathing should not be ignored.
Seek urgent medical evaluation for symptoms such as:
- sudden or severe worsening of shortness of breath
- difficulty breathing while resting
- severe chest pain or pressure
- fainting or near-fainting
- rapidly worsening swelling accompanied by significant breathing difficulty
- bluish discoloration of the lips or skin
These symptoms may indicate a serious problem and require prompt medical assessment.
PH and edema treatment
Treating edema in PH usually involves managing both the fluid buildup and the underlying cause of your PH.
The right approach depends on several factors, including your type of PH, your symptoms, the severity of your condition, and any other health problems you may have.
Not everyone with PH and swelling will need the same treatment.
Treating the underlying PH
Managing your PH is an important part of reducing further strain on your heart.
Depending on the type and cause of your PH, treatment may include medications, lifestyle changes, and surgery.
Diuretics for fluid retention
Diuretics, sometimes called water pills, are medications that help your body remove excess salt and water through urine. These meds may be prescribed to you to treat fluid retention and swelling. They may help reduce:
- swelling in the legs and ankles
- abdominal fluid buildup
- rapid weight gain related to fluid retention
Dosing with these medications needs to be adjusted carefully. Because of this, your healthcare team may monitor your symptoms, weight, kidney function, and blood tests while you are receiving treatment.Â
Do not change the dose of a diuretic on your own unless your healthcare team has given you specific instructions for doing so.
Reducing sodium
Consuming too much sodium can cause your body to retain additional fluid.
For this reason, your healthcare team may recommend limiting salt intake to help manage swelling.
Reducing highly processed foods, canned meals, deli meats, fast food, and salty sauces or seasonings may help lower your salt intake.
Choosing fresh foods and using herbs, spices, garlic, lemon, and other salt-free flavorings may make it easier for you to enjoy lower-sodium meals.
A daily monitoring checklist
Keeping track of changes may help you recognize possible fluid buildup earlier.
Depending on the advice of your healthcare team, you may want to monitor:
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| What to monitor | What to look for |
|---|---|
| Your weight | Check for rapid or unexplained increases |
| Your ankles and legs | Look for new or worsening swelling |
| Your shoes and clothing | Â Notice whether they suddenly feel tighter |
| Your abdomen | Watch for increasing swelling or bloating |
| Your breathing | Pay attention to worsening shortness of breath |
| Your energy levels | Note whether everyday activities are becoming more difficult |
| Your fluid intake | Track fluids if your healthcare team has recommended doing so |
If you notice a significant change, contact your PH care team rather than waiting for your next scheduled appointment.
If your healthcare team recommends monitoring fluids, remember that fluid can come from more than drinks. Soup, ice, gelatin desserts, and other foods that contain a lot of fluid may also count toward your daily intake.
The amount of fluid that’s appropriate for you depends on your symptoms and overall treatment plan.
Do not start restricting fluids without discussing it with your healthcare team.
Elevating your legs
If you have swelling in your feet or lower legs, elevating your legs may sometimes help relieve discomfort.
However, leg elevation does not treat the underlying cause of right-sided heart problems or fluid retention in PH.
If swelling is new, worsening, or accompanied by increasing shortness of breath, contact your healthcare team.
Oxygen therapy
You may need oxygen if your blood oxygen is low.
Oxygen therapy can increase oxygen levels and may relieve symptoms related to low oxygen. However, not everyone with PH needs supplemental oxygen.
Your healthcare team can determine whether oxygen therapy is appropriate for you and when it should be used.
Living with PH and fluid retention
New swelling can be concerning, especially when you are already managing shortness of breath and fatigue.
Paying attention to changes in your body may help you and your healthcare team identify fluid retention and decide whether your treatment needs adjusting.
If you have PH, consider discussing the following questions with your care team:
- How often should I check my weight?
- What amount of weight gain should I report?
- Should I monitor or limit my fluid intake?
- How much sodium is appropriate for me?
- What should I do if my leg or abdominal swelling worsens?
- When should I call my care team, and when should I seek emergency care?
The answers may be different for you than for someone else because PH and its treatment can affect people differently.
Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
