What causes pitting edema in heart failure

How to identify pitting edema

Edema refers to visible swelling caused by a build-up of fluid in tissues. If a depression remains after the swollen skin has been pressed, it is called pitting edema. The effect can also be noticeable after taking off a tight shoe or stocking.

Anyone can have pitting edema, but because some causes are more dangerous than others, it is often a good idea to see a doctor.

In this article we describe who is at risk for pitting edema. We also examine concomitant symptoms, treatments, and prevention techniques.

Symptoms of pitting edema

This condition is most common in the lower body, especially the legs, ankles, and feet.

Swelling caused by edema usually makes the skin tight, heavy, or sore. Other symptoms depend on the cause, but they can include:

  • Tingling or burning sensation around the swelling
  • Pain and pain in the swollen areas
  • Skin that feels puffy or stiff
  • Skin that is warm or hot to the touch
  • deafness
  • Flatulence
  • Water retention
  • cramps
  • unexplained cough
  • Fatigue or decreased daily energy
  • Chest pain
  • Shortness of breath and difficulty breathing

People who experience chest pain, shortness of breath, or swelling in one limb should seek medical attention immediately.

Pitting vs. non-pitting edema

Edema occurs when fluid that builds up in tissues causes swelling. When pressure is applied to a swollen area, it can leave a pit in the skin.

In the case of non-exuding edema, the skin returns to its swollen form after the pressure has been relieved.

Causes of pitting edema

A variety of factors can lead to pitting edema, including:

  • flying
  • poor circulation
  • obesity
  • pregnancy
  • Dehydration
  • low levels of protein
  • Trauma or injury

Alternatively, one of the following conditions may be responsible:

  • high blood pressure
  • diabetes
  • Psoriatic arthritis
  • Kidney problems
  • Lung disease
  • Liver disease
  • deep vein thrombosis, which involves a blood clot, often in the leg
  • chronic venous insufficiency, which occurs when the veins are blocked
  • Heart valve complications
  • congestive heart failure

Hole edema can also be a side effect of medications such as:

  • Steroids
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Drugs that supplement estrogen
  • Medicines for high blood pressure
  • Thiazolidinediones, a class of drugs used to treat type 2 diabetes

Risk factors

Pitting edema can affect anyone, although certain factors can increase a person's risk.

These include:

  • a sedentary lifestyle
  • Living in a warm climate
  • a diet high in sodium
  • obesity
  • Multiple pregnancies
  • a history of lymph node surgery
  • Thyroid disease
  • Lung diseases, such as emphysema
  • Heart disease

When to see a doctor

In most cases, a doctor should determine the cause of pitting edema and, if necessary, refer a person to a specialist.

Some accompanying symptoms require urgent care. If you feel short of breath, have difficulty breathing, chest pain, or swelling in any limb, seek medical help immediately.

If leg pain and swelling persists after a person has been sitting for several hours, it may indicate deep vein thrombosis. This happens when a blood clot develops deep in the leg. Anyone who suspects this should urgently seek medical help.

Pitting edema during pregnancy

Pregnancy can lead to edema and usually resolves around the end of the pregnancy.

However, it is a good idea to discuss any new symptom with a doctor who can assess whether serious conditions related to edema, such as very high blood pressure or preeclampsia, can be ruled out.

Diagnosis and classification

Hole edema is often diagnosed with a physical exam. The doctor may apply pressure to the swollen skin for about 15 seconds to check for any persistence.

Because some associated conditions are more dangerous than others, it is important to find the underlying cause of the edema. This may require thorough testing. The edema will usually be resolved once the cause has been addressed.

To properly identify the underlying cause, a doctor may take a detailed medical history and ask about medications. You can then refer the person to a doctor who specializes in issues related to the veins or the circulatory system.

Tests that can help diagnose pitting edema include:

  • a physical exam
  • Imaging tests, such as X-rays, that can show fluid retention and problems in the lungs
  • Blood tests
  • Urine tests
  • an echocardiogram, which is an ultrasound scan of the heart

Pitting edema is classified based on the depth and duration of the depression. The following scale is used to rate severity:

Grade 1: The pressure exerted by the doctor leaves a notch of 0-2 millimeters (mm) which immediately bounces back. This is the least common type of pitting edema.

Grade 2: The print leaves a 3-4mm indentation that bounces back in less than 15 seconds.

Note 3: The print leaves a 5-6mm indentation that takes up to 30 seconds to rebound.

Grade 4: The print leaves a depression of 8 mm or deeper. It takes more than 20 seconds to bounce back.

Understanding the severity of edema can help a doctor identify the underlying cause and the best course of treatment.


This involves tackling the underlying cause of the edema. A number of treatments match the range of causes, but common methods include:

  • raise the swollen limbs above the level of the heart
  • Wearing compression stockings to promote blood circulation
  • Underwent vascular surgery
  • Increase in blood protein levels
  • Take diuretics to flush out excess fluids


If the underlying cause has been treated successfully, edema is unlikely to recur.

Some lifestyle and diet adjustments can reduce the chances of developing edema, especially if a person is at high risk.

These changes may include staying active, avoiding long periods of sitting or standing, and doing gentle exercises to reduce swelling.


Hole edema is a common symptom. It is usually not a cause for concern in itself, but many basic conditions require treatment, sometimes urgent.

Edema shouldn't cause long-term complications. After working with a doctor, many people find permanent relief from the symptom.