Congestive Heart Failure and Compression Stockings.

The heart is a pump that moves blood throughout our bodies. This is called circulation. When the heart becomes weak or damaged it will circulate less blood than needed. When this happens fluid will accumulate in the body, we will talk about the legs in this article. Why do people get Congestive Heart Failure? Many times it’s like a car engine that has 200,000 miles on it. It is just tuckered out and needs to be pampered. If your legs are swollen when you go to the doctor, one of the things they often prescribe are compression stockings. Most likely knee high, these are made for both men and women. For women there are many fashionable sheer, thigh and full length panty hose styles that are also available. It’s important to take measurements in the morning for the size that you need, this is because the legs will be closest to their normal size. Our site shows where and how to take measurements for specific types of compression stockings. How important are compression stockings? Below are real life answers from people that wear compression stockings. Caring.com has a lady whose legs swelled so large that they developed blisters. Here is the story.

What can be done for swollen legs due to CHF?  

11 answers | Last updated: Nov 25, 2015

A fellow caregiver asked… Mom has had congestive heart failure (CHF) for many years. For the past month, her legs are so swollen she cannot bend her knees and now has small blisters forming at the ankles. She has been admitted to hospital many times for an IV diuretic. This usually takes care of the ankle swelling, but now that the whole leg is swollen it doesn’t do anything for the legs. It does, however, help her breathing which is probably why she is getting the IV in the first place. What can be done for the blisters and is this “to be expected” at this stage? Mom is 87.

EXPERT ANSWERS:

17044-latrella strimike

Carolyn Strimike, N.P. and Margie Latrella, N.P. are cardiac nurse practitioners specializing in the prevention of heart disease and stroke. They have over 40 years of nursing experience in Cardiology between them. The main goal of their work is to counsel, motivate and empower women to adopt healthy lifestyle choices.

Leg swelling due to congestive heart failure is very common. The swelling is due to excess fluid that backs up because the heart muscle is weak and cannot pump well. Diuretics are the usual treatment because they help the body get rid of excess fluid. There are numerous diuretics that can be used. If one diuretic is not working they can be used in combination along with other therapies. We would recommend that you consult with a wound care specialist to treat the blisters. Elevating your mom’s legs, limiting salt and fluid intake and wearing support stockings may help relieve the leg swelling which may in turn help the blisters heal.

COMMUNITY ANSWERS:

Kmfk15 answered…

I agree with the above answer, however salt doesn’t only mean table salt. All prepared foods are very high in sodium. Stay away from them. As far as the water blisters go I would see a dr. and he will recommend unna booths, elevation and home nurses for caring for the unna boots Good luck.

Mrs dunn answered…

Your mother’s doctor needs to also review the medications she is taking. The blistering can be a side effect of some common medications used for heart failure. In addition is is not uncomon to find that treating common skin fungus, in many cases with over-the-counter medications can control or prevent such blistering. It will require especial care to make sure that bedding, socks or stockings, and towels are kept scrupulously clean and changed daily.

Magedzaki answered…

Such cases are considered advanced stage of HF, and most probably those pt’s are already on combination diuretics, a matter which must be managed very cautiously, because of diuretic’s side effects(hypotension and electrolyte imbalance) so edema of lower limbs in such cases is helpful for the heart, as it might be considered a deloading factor for the already overburdened heart. The right thing is to consult the doctor about the right management of those extremely fragile patients , and the correct way of managing locally those blisters. dr. maged zaki

Deborah11155 answered…

Need to take care not to use Unna Boots without an ABI (measurement)obtained from MD or WOCN. This treatment should never be used haphazzardly. Also, compression should be used only with MD recommendation, especially with patient in active CHF. The edema (swelling) could travel upwards with the compression, causing increased cardio-pulmonary complications. Deborah T., RN, HCS-C, COS-D, SCHN.

Malind in black 01.jpg Msmalinda1947 answered…

I have CHF, and have blisters forming on both of my legs. Been to the ER room several times, as they got infected. What they did and told me to do, wash the infected areas several times a day, add a antibacteral suave on the wounds, cover in patches, cover that in gauze and then they gave me 2 very strong stretch gauze to wrap my legs very tightly to make the swelling go down. Did that for weeks. Let me tell you, this is NO a easy thing to control. I have scars on several parts of both legs, around the ankles mostly the size of your fists, and yet, little bumps form, and they start a new blister. It took me 2 years to heal from 4 blisters and now, I see another opened up, so back to the treatment, again. Best thing to do, is to keep legs elevated as much as possible, do walking instead of sitting around, and use those compression socks, day and night. It is no easy way, and you probably will never get free of blisters, they seem to make their way back, eventually.

Skee answered…

I have “Lymph Edema” and went through the swollen leg trauma where my legs actually swelled so bad that they would erupt and leak fluid from them.Aside from wearing the tight wraps applied by a Therapist and the method he used in therapy that he performed,elevating the legs did the trick.I now have legs that are normal size as long as I continue to wear the “Compreson Stockings”.

Dakamom answered…

My Mom had CHF for many years. She had the type of swelling Skee described above. The compression stockings are critical, though I am guessing they are already part of your Mom’s regimen. I would absolutely be in touch with her doctor about the level of swelling you are seeing. CHF is progressive, so it may be normal, but it needs to be managed by her doctor.

A fellow caregiver answered…

AS a home visiting nurse I have treated many pts with this problem. It is life long. Therapy involves diuretics, compression, moderate exercise (walking), and leg elevation.

Loulabelle answered…

Could it possibly be Bullous Pemphigoid? I’m a carer and I think one of my clients has been suffering with this for a while. Its an auto immune disease that effects over 70’s and can be brought on through the use of diuretics ( this is when my clients problem first started). The first symptoms may be small patches of itchy skin/ pink rash, before quite large bulbous blisters develop- blisters can occur on arms, legs, armpits or groin, or just one area such as the lower leg- which is currently where my client is suffering with it. Steroid medication such as Prednisolone and steroid creams are said to help, but it is difficult to get the right balance, and, as the disease can last between 1-5 years, the side effects that the steroids could possibly cause may be an issue. My own personal opinion is all the medication including the diuretics she is taking are likely to cause an autoimmune issue due to all the foreign bodies entering her system teamed with the fact she now eats very little, however the medications are all needed for some other aspect of her health so it is just a catch 22 really…

Okiesmom answered…

I had badly swollen legs with blisters forming and draining. I kept my legs clean and used cotton balls and rubbing alcohol to clean them several times a day. They have healed and I have not had a problem with blisters for at least two years.

Along with elevation of the legs, compression stockings are commonly used by people with Congestive Heart Failure to prevent Edema in the legs (water retention). The legs are prone to blood pooling and blood clotting. Compression stockings apply a gradient pressure, this means firmer pressure at the bottom that gradually decreases as the stocking goes up the leg. This effectively forces the fluids upward towards the heart. Pressure stockings are rated in mmHG, what is important is that you understand that the higher the number the greater the pressure. Example: a 30-40 mmHG stocking is stronger than a 10-20 mmHG stocking.

Most commpression hose wearer’s recommend buying a quality brand of compression stockings. The comfort and durability more than make up for any price savings. If your feet and legs have sores, it is advisable to buy a pair with silver in the compression stockings, yes microfibers of silver are woven throughout the stocking, this provides an antimicrobial feature and should help reduce infections.

When Choosing a Compression Stocking Dr. Ichinose (Director of Vein Services at Oklahoma Heart Institute at Hillcrest Medical Center) Advises:

First, all compression socks are NOT created equal. “The quality of the material, the sizing, the durability and the amount of compression or pressure the garment provides all culminate into the final product,” explains Dr. Ichinose. “Some very economical support hose are not sized by careful measurement of your leg.  They are labeled small, medium and large, however the amount of compression provided is not known.”

Dr. Ichinose advises patients to know two important things before selecting compression socks: the amount of compression and the size needed. Your health care provider will advise the compression level you need, as well as measure your leg to make sure you are fitted in a proper compression sock. However, you can also measure yourself for compression socks. In the morning before swelling occurs, measure the circumference of your ankle (around your ankle), the circumference of your calf and the length of your calf (from the knee to the heel sitting with your legs at a 90 degree angle). Use the sizing guide on the compression sock packaging to find the right fit for you. If you have any questions about the compression level appropriate for you, talk to your health care provider. Compression levels range from mild compression to extra firm compression:

Mild compression 15-20mmHg:  Prevention and relief of minor to moderate varicose veins, relief of tired aching legs, relief of minor swelling of feet and legs.

Moderate compression 20-30mmHg:  Prevention and relief of moderate to severe varicose veins, treatment of moderate to severe lymphatic edema and management of active ulcers or post thrombotic syndrome.

Firm compression 30-40mmgh: Ulcer management, post thrombotic syndrome.

“The amount of compression provided by a pair of socks will vary depending on the size of the leg in relationship to the size of the garment,” shares Dr. Ichinose. “Patients commonly complain that the compression socks cut into their leg.  Usually it is because a large leg was placed in a garment too small for the leg.”

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