Page 27 - Clinical Pearls in Cardiology

History and General Examination 15

23. Which are the drugs that commonly produce pedal
edema?
Some drugs can cause pedal edema. The most important
medications that are implicated in the genesis of pedal
edema are the following:
• Vasodilators (like dihydropyridine CCB’s like
amlodipine)
• Hormones (like estrogen, progesterone, steroids, etc.)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Pioglitazone.
Because medication induced edema is caused by
capillary hypertension, diuretics are not an effective
treatment. However, angiotensin-converting enzyme
inhibitors and angiotensin receptor blockers seem to be
effective in managing some cases of medication-induced
pedal edema.
24. What are the causes for edema in heart failure?
The common factors responsible for edema in patients
with heart failure are the following:
• Impairment of renal blood flow: This promotes
excessive reabsorption of salt and water by activating
the renin angiotensin mechanism
• Increased venous pressure: A rise in venous pressure
proximal to the failing heart promotes edema
formation
• Endocrine adaptations: Secondary hyperaldostero-
nism and increased vasopressin encourage salt and
water retention
• Reduced plasma oncotic pressure: Chronic
congestion of the liver due to right heart failure
reduces albumin synthesis