Edema

About four months ago I had surgery for mitral valve replacement, tricuspid ring and ablations in both atria.  My EF is around 50-55%.  I have clean coronaries.  I have had an AV node ablation for persistent and re-occuring atrial fib/flutter so am totally pacemaker dependent with VVVIR pacing.  I am now on amiodarone and have been for about two months.  Soon I will be cardioverted one last time and if it works, they will repair my atrial lead which was damaged in surgery so that I can have AV sequential pacing etc..  I did well after this second surgery, was building up stamina, had very little peripheral edema.  I was taking just 20 mg of demadex. About two weeks ago, I started experiencing increased periperal edema, now about 2+ up to my knees.  Actually it is worse now than before surgery.  My stamina has decreased and I feel very sluggish. I have increased the demadex to 40mg AM and 20 PM but there is still significant edema. The only other drugs I take are potassium, levoxyl, calcium and rocaltriol.  My cardiologist states that he doesn't know why this happening. I wear TEDS for work, don't eat that much salt, no drinking etc.  I exercise most every day though it is difficult for me.  What tests should I ask to be done?  Would an echo be helpfull at this point or a stress echo?  or do I need to accept the fact that I will always have this edema thing?  By the way, edema is painful and uncomfortable. I know we see it all the time but it is awful to experience.  Anyway, any thoughts on this scenario would be appreciated.

[Cleveland Clinic]

kristin,

thanks for the post.

It really is impossible to comment on the chonicity of your edema. There are other causes even beyond fluid that can cause edema.  Even hypothyroidism can contribute, so a good history and physical is needed.

If you had surgery on your tricuspid and mitral valves, there is a chance that there could be damage to the right ventricle that could be contributing.The degree of your edema seems out of proportion to your EF, so I would suspect if there were a problem it would be related to the right ventricle, tricuspid valve or pressures in your lungs. An echo might help discern or rule out cardiac causes for your symptoms.

As far as therapy it will depend on the cause. Trying to restor your intrinsic rhythm will be of help as they try to adjust your medications.

good luck