Page 26 - Clinical Pearls in Cardiology

14 Clinical Pearls in Cardiology

Fluid overload: Elevated JVP, slow edema
Hypoproteinemia: Normal JVP, fast edema

21. What is meant by ‘idiopathic edema’?
The most likely cause of leg edema in women under the
age of 50 is idiopathic edema (formerly known as cyclic
edema). Idiopathic edema occurs only in menstruating
women and is most common in the age group of 20s and
30s. Idiopathic edema is a syndrome of fluid retention
with swelling of the face, hands, trunk and limbs,
occurring in premenopausal women in the absence of
cardiac, hepatic or renal disease. Diabetes, obesity and
emotional problems are commonly seen as part of this
syndrome. Idiopathic edema leads to pathologic fluid
retention in the upright position, and women typically
notice a weight gain of more than 0.7 kg to 1.4 kg as the
day progresses. This edema is probably due to variations
in the capillary permeability.
Spironolactone is considered the drug of choice
for idiopathic edema because of the secondary
hyperaldosteronism found in patients with this disorder.
It is best to avoid loop diuretics. Other measures include
low salt diet and weight loss for obese patients.
22. What is premenstrual edema?
Most women experience some premenstrual edema
and weight gain. The edema tends to be generalized,
occurs a few days before the beginning of menstruation,
and resolves with diuresis that occurs with the onset
of menstruation. The etiology is poorly understood. It
is important to distinguish premenstrual edema from
idiopathic edema.