Pitting edema 2nd trimester pregnancy

Increased Heart Rate During Pregnancy

An elevation in rate of heartbeats is enough to scare just about anybody and experiencing increased heart rate during pregnancy can be all the more disconcerting. However, it is important to realize that there are many changes that take place with a pregnant woman’s body, right from the first few weeks of pregnancy, till the baby is born.

Causes of increased heart rate during pregnancy

Causes of increased heart rate during pregnancy

During pregnancy, the flow of blood from the heart needs to increase, to meet the additional requirement of the body.

This is the main cause of increased heart rate during pregnancy. After a woman conceives there are several alterations that gradually take place within her circulatory system, to accommodate the baby’s requirement for oxygen too. During pregnancy, the blood that reaches the baby through the placenta should carry the required amount of oxygen and nutrients, to ensure that the fetus develops properly. Due to this, the cardiac output of the heart increases by 30% to 50%.

Increased heart rate pregnancy symptom

During the first trimester, it is normal for a woman’s heartbeat to increase by around 15 or 20 beats per minute.

However, at times, other unfavorable may be seen in addition to the increase of heart rate. These unfavorable symptoms could include:

  • Pounding or racing of the pulse
  • Uneven breath or shortness of breath, even when the woman is not active
  • Fainting spells, dizziness or lightheadedness
  • Palpitations
  • Feeling of skipped heartbeats
  • Persistent cough

Hence, in case any of these symptoms are seen it is important to visit the doctor and go through an exam, just to make sure that the baby is alright. In case a woman experiences severe shortness of breath and increased heart rate during pregnancy, it is best for her to consult her doctor at the earliest. Moreover, increased heart rate during early pregnancy should be checked by a doctor too.

Second Trimester

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From the Message Boards

About 2 months after my 2nd trimester pregnancy loss of twins at 22 weeks June 3 2015, I had terrible bouts of anxiety and panic attacks. I have been to my doctor and they did full panel blood work up and they all came back “normal”, but I still felt really tired and out of sorts,low energy, foggy mind, I couldn’t eat, I could barely get out of bed most days, I had lost weight, Terrible insomnia,terrible panic attacks and one even landed me in the emergency room:o I thought I was going to die, a.

Let’s start another list for the second trimester! We’re going to collect these and post them (with answers) as a FAQ thread for our board to help out newbies. What questions do you, have you or did you have during the second trimester or about the second trimester of pregnancy?.

This is my first pregnancy, and I’m 15 weeks along. Last night, I went to the bathroom, and when I wiped, there was a very light pink tinge to the toilet paper. I had brown spotting at 8 weeks, and everything was normal, but pink means active bleeding, right? I hadn’t been doing anything strenuous or anything. The only thing I can think of is that I sneezed really hard last night, and it hurt down in my womb for a couple seconds. Another thing is that for a week or so, I’ve felt like I’ve been a.

I’m due 7/30, and today starts my second trimester. I must be one of the last if not the last one to start it. Here’s to the next 3 months being much easier on all of us! Hopefully, we’re mostly past the morning sickness phase, fatigue will be lessening any day now, and those of us who want to will be finding out our babies’ genders soon (and some already have)! It will be an exciting next few months. They call it the honeymoon of pregnancy, and I sure hope that’s right!.

Now that we are all in our second trimester (Katie and Brittanie, I think you are right? or are you a few days out yet?) Take a moment to sign up for the free mailings. For your first time mommas who might not know, most of the major baby companies will have a mailing list and mail you coupons and samples. if there are more I’m mising let me know and I”ll edit to add them..

DiagnosisDude

Not an uncommon complaint, often benign, sometimes ominous. We’re talking about pitting edema; non-pitting lymphedema is rare, associated with lymphatic disorders [which can also pit] & hypothyroidism.

The best way to quantitate the edema, which is essential during follow-up, is by body weight.

Determine if the edema is unilateral or bilateral. Unilateral pedal edema is due to venous obstruction. Venous obstruction is due to:

  • Proximal thrombosis. Order a duplex venous ultrasound ASAP on anyone with new onset unilateral edema, before they wind up with a pulmonary embolism.
  • Chronic venous insufficiency, common in women who’ve had many pregnancies, but possible in men or anybody whose venous valves give out with age.
  • Focal lymph node enlargement, neoplastic or infectious [uncommon].

Systemic causes of pedal edema can also begin unilaterally, since slight venous incompetence is easily asymmetric, showing up first on just one side. But then they turn bilateral.

From now on, we’ll be discussing bilateral pedal edema. Note that all systemic etiologies in the Table below cause sacral instead of pedal edema in patients who are bedridden.

CAUSES OF BILATERAL PEDAL EDEMA

  • Congestive Heart Failure
  • Anemia (causing CHF)
  • Cor Pulmonale (Right CHF)
  • Pulmonary Embolism (cause of right-side failure)
  • Nephrosis / Renal Failure
  • Cirrhosis / Portal Hypertension
  • Hypothyroidism
  • Venous Insufficiency
  • Late Pregnancy (usually obvious)
  • Medications (Ca ++ Channel Blockers, Thioglitazones, NSAIDs, Estrogens)
  • Malnutrition (severe)
  • Diuretic Dependence
  • Persistent Immobile Upright Posture
  • “Idiopathic edema”

The work-up is straight forward. Start off looking for serious etiologies, quickly summarized by remembering target organs:

  • Heart (R & L)
  • Kidney
  • Liver
  • Anemia
  • Thyroid

During the initial visit, address Heart Failure and Cirrhosis by History & Physical Exam:

Other Findings in Heart Failure

  • Dyspnea on Exertion (DOE)
  • Orthopnea
  • Paroxysmal Nocturnal Dyspnea
  • Recent Chest Pain (suggests MI)
  • Bibasilar Rales
  • Jugular Venous Distention / Hepatojugular Reflux
  • Tricuspid Regurg and Loud S2 (in cor pulmonale)
  • S3, S4 gallops
  • A. Fib; pathologic Murmurs (as causes of CHF)

Auscultate carefully at the lower left sternal border for Tricuspid Regurgitation, which immediately points to pulmonary hypertension & likely cor pulmonale. Click for a description of Tricuspid Regurg , and comments about listening for murmurs in general.

Especially consider Pulmonary Embolism, a common cause of Cor Pulmonale. Seek clinical clues:

  • New onset DOE
  • Sudden onset SOB (within 1 minute)
  • Risk Factors: Prior Hx PE or DVT, Immobility, active Cancer
  • See our posting on PE ( Acute Dyspnea-2 ).

In terms of Liver Disease / Portal Hypertension:

Stigmata of Cirrhosis

  • Jaundice
  • Spider Angiomata on chest ( pix )
  • Enlarged liver (palpate / percuss)
  • Distended abdominal veins ( pix )
  • Ascites
  • Gynecomastia
  • Palmar Erythema
  • Testicular Atrophy (I don’t routinely check for this)

The H&P may clue you in to a likely cause, but still…

CBC, Chemistry Panel, BNP, TSH, U/A, EKG

  • CBC — for Anemia; (also ↓ Platelets in Cirrhosis)
  • B-Type Natriuretic Peptide (BNP) — for CHF
  • Creatinine & BUN — for Nephrotic Syndrome / Renal Failure
  • LFTs — for Cirrhosis / Liver Failure (may be deceptively normal)
  • Serum Albumin — for Cirrhosis and Nephrotic Syndrome
  • TSH — for Hypothyroidism
  • Urinalysis — for Nephrotic Proteinuria (causing hypoalbuminemia)
  • EKG — for recent MI, a possible cause of new CHF
  • Echocardiogram — if reasonable suspicion of CHF (right- or left-sided)

Anemia is a common cause of edema, mediated essentially through mechanisms equivalent to CHF. It has to be significant, e.g. Hgb / Hct around 8 gm / 25% (rapid blood loss can cause edema at higher counts). Once you diagnose Anemia as the cause of edema, you need to identify its cause as well (iron deficiency, B12 deficiency, etc). And if it’s Iron Deficiency, you’d better find out why (e.g. colon cancer? ulcer?). See our recent postings [ Anemia-1 (Intro) , Anemia-2 (Microcytic) , Anemia-3 (Macro- & Normocytic) ].

CHF likewise; diagnose this, then ask, “Why?” Longstanding HT? Recent MI? Arrythmia? Valvular Disease? See our posting Acute Dyspnea-3 . I read of one case of a man with edema and ascites for 3 years before being diagnosed with constrictive pericarditis with right-sided failure, masquerading as cirrhosis.

Cor Pulmonale (Right Heart Failure) of new onset equals Pulmonary Embolism until proved otherwise. Order a helical chest CT or V/Q Scan ASAP. The CT is usually quickest to obtain, but the V-Q scan is more sensitive for chronic PEs.

Portal Hypertension causes ascites & edema due to venous congestion & stasis.

Cirrhosis causes ascites & edema due to both Portal HT & also low colloid osmotic pressure from hypoalbumenia (due to decreased synthesis).

Nephrotic Syndrome causes hypoalbumenia via proteinuria. A urinalysis would have to be maximum “4+” because a 24-hour collection is >4 grams.

So what happens when there’s no clinical suggestion of CHF or Liver disease, and all labs return normal? Consider an echocardiogram if the edema is significant, though the BNP is an excellent surrogate. You reassure the patient of all the terrible conditions they don’t have, and make a diagnosis of Venous Stasis.

Venous Stasis?? Recommend elastic stockings. Makes me a little nervous, but indeed, we sought what we could, & came up with all negatives. Of course, consider new Medications that commonly cause edema:

  • Calcium Channel Blockers (dihydropyridines): nifedipine, amlodipine, felodipine
  • Thioglitazones: pioglitazone, rosiglitazone
  • NSAIDs (though suspect occult CHF if NSAIDs cause edema)
  • Estrogens

Discontinue any of these and see what happens.

By all means, also discontinue any diuretics the patient may have been taking. Perhaps not HCTZ taken long-term for HT. But certainly furosemide or other loop diuretics [which don’t even work well for B/P control]. These may have been taken surreptitiously for weight loss, or prescribed for minor degrees of venous stasis edema. Will need to discontinue and be patient for up to 3-4 weeks, employing elastic hose as you go. Not easy.

As for the few other entities in the differential, well, hopefully there won’t be a problem in recognizing 3 rd Trimester Pregnancy. Or Severe Malnutrition.

Persistent Upright Posture is a common cause of pedal edema, especially if the patient reports that the swelling fluctuates, or comes & goes. Some examples I’ve seen:

  • Homeless person sleeps sitting up
  • Elderly person with severe back pain spends entire day in chair

A syndrome of “idiopathic edema” of hands & face as well as feet has been described in premenopausal women, different from premenstrual fluid accumulation. It’s a diagnosis of exclusion, associated perhaps with obsessive weight loss or purging, and diuretic abuse. I’m not convinced.

wiseGEEK: What are the Causes of Pitting Edema?

The causes of pitting edema are usually linked to an underlying condition that affects various organs or limbs of the body, causing fluid retention. The most common underlying diseases include heart disease, kidney disease, and liver disease. In addition, varicose veins and inflamed veins may be causing pitting edema. Pitting edema may also be caused by pregnancy, poor diet, and certain medications.

Edema is the swelling of a person’s body tissue, usually in the legs, feet, hands, or arms. The swelling is caused by an accumulation of body fluids underneath the surface of the skin. Pitting edema can usually be identified when a person applies pressure to the swollen portion of the skin. If pitting edema is present, an indication will persist after the pressure is released. Pitting edema is more common that non-pitting edema, where an indentation does not persist after the release of pressure to the swollen area.

The main causes of this condition include systemic diseases, or diseases that affect organs of the body. These systemic diseases may include heart, kidney, and liver disease. With these ailments, edema generally occurs because the body retains an overabundance of salt. The abundance of salt forces the person to retain water. The water then seeps into the spaces between layers of tissue, where it then materializes as pitting edema.

Other common causes of this condition include varicose veins and a condition called thrombophlebitis, or inflamed veins. With varicose veins and thrombophlebitis, the blood does not pump adequately through the veins. The insufficient blood flow can create pressure within the veins, forcing body fluids to collect in the peripheral extremities, primarily in the feet and ankles. As the fluid collects, it can leak into the spaces between the tissue layers, creating pitting edema.

Pregnancy may be another cause of pit edema. During pregnancy the uterus may put additional pressure on one of the main blood vessels called the vena cava that pumps blood from the legs to the heart. In addition, an increased release of progesterone may cause the wall of some blood vessels to relax, decreasing the flow of blood from to the heart from the legs. When this happens, fluid may be retained and pitting edema may occur.

Other causes may revolve around a poor diet or obesity. For example, people who are overweight or who consume foods and drinks with high amounts of salts may be more prone to pitting edema. If a person is malnourished, she may have insufficient protein levels in her blood. The blood proteins help trap water within the blood vessels. If the water leaks out of the blood vessels and seeps into the spaces between the layers of tissue, edema may occur.

Some medications may cause pitting edema as well. For example, nonsteroidal anti-inflammatory drugs (NSAIDs), estrogen, certain drugs for diabetes, and some blood pressure medications may cause the condition. In addition, anabolic steroids, corticosteroids, and calcium channel blockers can result in pitting edema. If edema is suspected, a medical provider should be consulted.

Article Discussion

2) I had some minor pitting edema in my legs before I got on blood pressure medication. My doc also put me on a mild diuretic. Getting my blood pressure down and taking the diuretic really helped the edema and now I don’t have any at all.

My blood pressure medication is an ACE inhibitor, so it’s not apt to cause edema, thank goodness. My kidneys and liver are in good shape too, so I’m thankful. Pitting edema is scary because it’s almost always a sign of something that isn’t good, and may or may not be treatable. I’m glad mine was solved with medication.

1) My mom is 85 and has pitting edema in her legs. It’s worse on the side where she had a hip replacement, but she doesn’t have any heart, liver or kidney issues. She probably has it from her blood pressure medication, which is a calcium channel blocker. Her doctor is talking about changing her medication, but is a little reluctant since her blood pressure is well controlled with it.

She also has some mobility issues and isn’t able to do much exercise, which I’m sure contributes to the problem. So, pitting edema can definitely be a side effect of medication.

Sources:

http://www.pregnancy-baby-care.com/conditions-during-pregnancy/increased-heart-rate-during-pregnancy.html

http://www.justmommies.com/pregnancy/second-trimester/3.html

Pedal Edema

http://www.wisegeekhealth.com/what-are-the-causes-of-pitting-edema.htm

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