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Swollen ankles

Swollen ankles are a common symptom than can suggest an underlying heart problem but it is important to note that not all people with swollen ankles have a heart problem.

 

Symptoms

People who have swollen ankles and an underlying heart problem may also have a number of other symptoms. These are listed below:

  • Breathlessness

  • Difficulty lying flat in bed

  • Waking up breathless in the night

  • Exercise intolerance

  • Palpitations (awareness of heart beat)

  • Dizziness

  • Abdominal bloating

  • Low mood

       

Causes

There are a number of different causes of swollen ankles. Cardiac causes include a reduced ability of the heart to contract to meets the needs of the body, also referred to as heart failure. There are a number of different causes of this. Non-cardiac causes include gravity and immobility, for example being on your feet all day, usually in warm weather or elderly patients who are largely chair bound; abnormality with the kidneys and liver and conditions that reduce the return of blood to the heart (blood clots in the veins or deep vein thrombosis), external compression of the veins reducing blood flow to the heart.

 

Investigations

There are a number of different investigations that can be performed to investigate the causes of swollen ankles and these include:

  • Blood tests to look for anaemia, infection, liver and kidney failure all of which can produce similar symptoms of heart failure are important to perform

  • Measurement of NT-proBNP, a protein released by the heart when it is stretched.

  • A chest X-ray to assess the lungs and assess the size of the heart

  • An ECG or electrocardiogram is an electrical reading of the heart that is performed by placing electrode stickers on the skin of the chest wall.

  • Ultrasound of the heart or echocardiogram is a test used to assess the structure and function of the heart. This will determine whether the heart’s squeezing or stretching ability is inhibited.

  • A cardiac MRI can be performed to have a detailed assessment of the heart’s structure and function.

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