Swollen Ankles and Feet

Swollen ankles and feet

by Sisterwash65 - 2021-01-02 11:28:36

Hi Al.495...Your post caught my eye because I have the exact same Medtronic Azure MRI compatible pacemaker and I too had bradycardia as well as Heart block. I read your bio but I'm still not sure about your swellings. Have you had the swellings since your ablation ? If so, has your doctor addressed it ? 
Also wondering what medications you're on. There are others here who should be better able to answer your questions with a little more information.

Hang in there. Hasn't been long since your PM was implanted. Hoping you get relief soon !

Fluid Retention

by Gemita - 2021-01-02 12:06:14

Hello AL_495,

I believe edema (water retention) can occur following an ablation because they usually inject a saline solution into the body during and after the procedure.  Not totally sure why?  Perhaps someone can advise.  Whatever the reason, if you are able to drink plenty of plain water, this should help remove any excess sodium from your system.  

After any procedure, with a local or general anaesthesia and the necessity to lie still for several hours during the ablation and afterwards, many of us can expect to suffer from some fluid build up, but as we start moving around this should disperse.

As Sisterwash65 asks, have you been given any new meds because some meds can cause ankle swelling?  I am thinking here of say a Calcium Channel Blocker like Amlodipine which quickly caused ankle swelling for my husband.  

If however your ankle swelling came on or worsened after ablation, I would think it would be the sodium they might have injected prior/during the procedure, but do query with your doctors if the fluid doesn't disperse.  They might want to check how well your pacemaker is functioning, whether the settings are right for you, whether your heart needs extra support - perhaps a higher heart rate setting to help your heart work better and help disperse the excess fluids.

Welcome to the forum and I hope your PVCs are no longer causing problems for you.  Do you know whether you had an ablation due to heart failure symptoms (caused by poor left ventricular function/cardiomyopathy)?  It can take a few months to see any improvement following a PVC ablation, and if this is the case, fluid retention may continue to be a problem for a while while healing takes place.  But please let your doctors know about your continuing problems.

Edema

by AgentX86 - 2021-01-02 13:46:09

Edema is a sign that something isn't right.  It's the first sign of heart failure (though could be dozens of causes) and your doctors should know, immediately.  My doctors were constantly checking for it after my implant.  Well, they always check because I have very large calves from walking.  No water, all muscle. ;-)

To answer Gemita's question, they use a saline IV to avoid dehydration, during surgery, as well as a channel they can use to get anesthtic into you and other drugs into you quickly in case anything goes sideways.  The saline is also sort of a "blood-helper" in that it looks like blood without the important parts.  ;-)  It takes volume in the bloodstream helping to stabilize blood pressure.  The salt in saline solution shouldn't cause edema any more than drinking a few liters of water would cause edema.  It has about the same salt content as blood.  That's the point of it.

Far too prolonged for this fluid retention to be temporary

by crustyg - 2021-01-02 15:48:34

Hi: You'd have to give a *lot* of normal saline IV to produce leg oedema - enough to push many patients into 'heart failure' which would result in poor lung function and reduced oxygen saturation.  Depending on how quickly you give it, it would be 2L or more to produce this - and if you have normal kidney function you'll pee it out very quickly.  Yes, there *is* an issue with ANP production (not enough) for some patients who've had long term AFlut/AFib, and since this is a key hormone to instruct the kidneys to dump sodium (and water with it) there may be a slowed excretion of any IV normal saline.

I don't think this is related to the PM procedure unless they ablated a *lot* of ventricular muscle, or you had a small MI during the procedure.

I'd go back to my EP doc (or send pictures of your swollen legs/feet: tip, press firmly over the shin-bones with both thumbs for 15s and then take a picture of your legs with a strong light source from feet towards your trunk - makes any depressions made with your thumbs show up better in the pictures).  You probably need an echo to a) assess %LVEF, b) check IVC sniff-test (look it up), assuming your kidney function is ok.  You *may* have a mild cardiomyopathy (lots of potential causes), as it sounds from your history that the ankle oedema pre-dated the ablation/PM implantation.

The swelling *may* get a little better but most of that improvement will probably have happened by now.  I suspect a small starting dose of a diuretic may be appropriate - a thiazide probably.

Best wishes.

crustyg and AgentX86

by Gemita - 2021-01-03 06:02:11

https://www.eplabdigest.com/catheter-ablation-ventricular-arrhythmias-using-half-normal-saline

Thank you both for your answers about the saline.  I am sure you are both correct.  I was thinking more in terms of whether they might have used additional saline amounts to assist/improve ablation technique during the procedure and whether this could possibly have been a contributory cause for AL_495's edema.  Please see last para before Conclusions of above link.  

As you both say, whatever the cause, AL_495 certainly needs to get an opinion from his medical team and a firm diagnosis and treatment plan

I agree with everyone that it sounds like edema, but...

by asully - 2021-01-03 12:26:47

The fact that you added "toe stiffness" makes me wonder if something "non-heart related" is going on.  First thing to figure out is if it is inflammation, edema, or pitting edema.  If you think it is for sure edema push your thumb into a spot (over a bone area works best) for 20-30 seconds, if it leaves a dent it's pitting edema.  Pitting edema is a sign of fluid overload and usually gathers in our legs and feet due to gravity.  It can be caused by over a dozen different things (including as a side effect of many meds), but it also a key indicator that something is not right.  I would go in right away and have a full work up done if this is new to you.  While you wait to get in to see someone start tracking your weight daily, this will be useful for your practitioners, if you notice an increase in your weight of over 10 lbs in a week I would push for an urgent appointment.  I ALWAYS retain water after surgery because they give so much by IV, then spend weeks using diuretics to flush it out, I have persistent edema but it is manageable.

Thanks for Comments on My Post

by Al_495 - 2021-01-04 07:35:10

Just wanted to thank those who have commented on my post regarding awollen feet, ankles and stiffness in the toes. Your comment are helpful.

I had these symptoms pror to the ablation procedure and pacemaker implant. I had thought they were a result of my bradycardia and PVC's. Since it's been around 3 weeks since surgery, I had thought I'd see a reduced swelling or the symptom go away. I was not on any prescription heart meds prior to the surgery or afterwards. My doctor did have me stopped an 81 mg aspirin and start taking a 325 mg dosage, but that was for reducing a chance on blood clotting, I believe.

I'll be taking the advice given and contacting my doctor before my next scheduled appointment and advising him of my concern. Thanks again.

Al

Aspirin

by Gemita - 2021-01-04 09:04:26

Hello Al,

Thank you for the update.  A thought just crossed my mind when I saw you were taking Aspirin.  My husband was taking Aspirin for stent protection and it increased his uric acid levels, leading to an attack of gout (which he suffers from).  He had swollen feet and toe stiffness but also a lot of inflammation.  Some people are very senstive to Aspirin.

I would maybe ask your doctors to check your uric acid levels since I see that you have toe stiffness and swollen feet too.  Do you have any redness around your toe joints?  It might be worth getting them to check your uric acid levels and other inflammatory markers.

Another question for your doctors would be if daily Aspirin is really necessary since you say you do not have any major health problems?  

I am on anticoagulation daily (Edoxaban) for Atrial Fibrillation stroke protection to prevent blood clots.  I was told by my Anticoagulation Clinic that Aspirin was not the med of choice to protect against a blood clot (although it is often used in combination with other treatments, specifically after stenting for a limited period only).  I was further told that daily Aspirin could be dangerous and increase the risk of a serious bleed - blood vessels, brain, gut.  They said as a "preventative" measure only, taking daily Aspirin was not worth the risk, and as a necessary measure, in my case, to protect from an AF related stroke, the newer novel oral anticoagulants (like Apixaban and Edoxaban) were safer and more effective in preventing a blood clot than Aspirin.

Aspirin

by AgentX86 - 2021-01-04 23:07:33

Gemita, you're absolutely right. Because of the issues with aspirin that you raise, it is no longer advised as an anticoagulant.  It was never a good choice but some cardiologists thought it was better than nothing for those at low risk.  It's not.

I thought xarelto was specifically for stents and heart valve patients.

Gout is certainly not a good thing.  I don't think I've ever had pain as bad as my, once regular, attacks of gout. That includes the pain from my CABG, including bronchitis ten days later.  Doctors thought it was RA for some time, until my PCP here (I was 60 at the time) saw it.  He then referred me to, what he said, was the best rhumatologist in this part of the state.  He put me on Febuxostat (Uloric) and I haven't had an attack in the years since.  Great stuff but like any drug it's not for everyone.  It's been a wonder drug for me.

AgentX86

by Gemita - 2021-01-05 04:11:45

Yes gout is an awful condition.  Hubby’s feet were so swollen one time, he could hardly walk for weeks.  He was put on Allopurinol and now only needs maintenance, alternative day treatment to keep his uric acid levels down.  Oh and no wine and avoidance high purine foods which he seemed to love.

AgentX86 if I am not mistaken, Xeralto and all the other novel oral anticoagulants are not safe to take with artificial heart valves.  They still use Warfarin for these patients I believe.

After Michael’s stents (3 in number) he was placed on triple therapy for stent protection:   Aspirin, Clopidogrel, Apixaban for 3 months, then they dropped Clopidogrel after 3 months and Aspirin after one year.  Now he is only taking Edoxaban for AFib.  They wanted to give him Xeralto instead of Apixaban after stenting but because of the high risk of a bleed on triple therapy, doctors felt Apixaban would be far safer and switched him to low dose 2.5 mg Apixaban until he came off Aspirin, then they switched him to low dose Edoxaban 30 mg because of his poor kidney function.  Low dose Apixaban 2.5 mg would not have been adequate for AF stroke protection whereas low dose Edoxaban is apparently.  I am also on Edoxaban 30 mg

Eliquis vs. Xarelto vs Warfarin

by AgentX86 - 2021-01-05 18:08:13

At first I took allopurinol for my gout but it was only partially effective.  Allopurinol is really an anti-inflamitory and as such treats the symptom rather than the disease.  Uloric goes right to the point.  It was quite expensive but the generic just came out so it's more reasonable.

Eliquis (and I assume from what I've read about Xarelto) hasn't been through FDA trials as an anticoagulant for (mechanical) heart valves so use in the US would be "off label". This puts the doctor at a risk of a liability law suit. Doctors get quite defensive about such things.  Eliquis is advertised for "atrial fibrillation caused by other than heart valve...".  This is probably why Xarelto is used for stenting rather than Eliquis, too.  Eliquis has been shown to be a (slightly) safer drug but no doctor is going to get on the wrong side of the FDA and trial lawyers.

I know of one person who uses low-dose Eliquis (apixaban) as an anticoagulant for AF but he's had a Watchman implanted.  The Eliquis is a belt and suspenders sort of thing. I've had my LAA closed (AtriClip) too but my EP looked at me like I had a third eye when I asked if I could get off anticoagulants.

Swollen Ankles and Feet Update

by Al_495 - 2021-01-13 20:37:14

My doctor ordered a chest x-ray and a BNP, Brain Natriuretic Peptide, blood test when I called him regarding my swollen feet and ankles. The BNP results were flagged high with a 137 reading, but my doctor didn't seem to concerned. I did mention to him that I do get up at night to urinate and thus probably do not get enough sleep.

The swelling in my left ankle and foot has gone down some, but my right foot and ankle are noticably larger than the left.

He exmined my ankles and feet, ordered a low dose of Lasix to take for 2 days and scheduled an ultrasound on my right leg. During the ablation removal of the cather in my right leg, there was a complication where the was difficulty getting the puncture to stop bleeding. 

The chest x-ray looked normal.

Al