Symptom: Swelling and Sudden Weight Gain

Reviewed by: HU Medical Review Board | Last reviewed: May 2024 | Last updated: May 2024

Heart failure (HF) is an increasingly common health problem. In fact, it is the most common reason people over age 65 in the United States have to stay in a hospital. In people with HF, the heart is either too weak or too stiff to pump enough blood through the body.1,2

HF has many symptoms. Some common ones are feeling tired a lot of the time (fatigue), shortness of breath, and chest pain. Another common symptom is swelling (edema), usually in the legs or feet. This swelling usually leads to weight gain. Often, 1 or more of these symptoms are the first sign of declining heart health.3,4

What does swelling with HF look and feel like?

Swelling can be a symptom of many health conditions, and it can occur anywhere on the body. With HF, it most often occurs in the legs, ankles, or feet. Your stomach area (abdomen) may swell up as well. It may feel hard to the touch or stick out more than usual.3,5

Overall, you might notice that your clothes or shoes suddenly fit more tightly. Your skin may seem to be stretched over the affected area or appear shiny. After you press on a swollen area, a dimple may remain for a few seconds (called pitting edema). Extreme swelling can be uncomfortable or even painful. And it can restrict your ability to move around freely.6,7

HF also can lead to a more dangerous form of swelling called pulmonary edema. This is swelling caused by fluid building up in the air sacs of the lungs. Swelling in the lungs leads to shortness of breath. If it occurs suddenly, this type of swelling can make it very hard to breathe and can be life-threatening.8

Why does HF cause swelling?

When your heart can no longer pump blood effectively through your body, your blood flow slows down. Blood backs up and begins to collect in the veins, and fluid builds up in the surrounding tissues. This causes swelling.3,5

Swelling can lead to weight gain due to the extra fluid your body is holding. Gaining more than 2 or 3 pounds in a single day, or more than 5 pounds in a week, may be a sign of HF.4

How is swelling treated?

To treat swelling directly, your doctor may prescribe a diuretic, sometimes called a water pill. These drugs help you flush excess fluids from your body. Pulmonary edema may require additional treatment, such as extra oxygen or blood pressure drugs.2,9

You can help prevent swelling in the first place by adopting healthy lifestyle habits like the following:2,10

  • Quit smoking right away if you smoke.
  • Get regular, moderate-intensity exercise.
  • Get plenty of rest and manage your stress levels.
  • Eat a heart-healthy diet with low salt (sodium).
  • Reduce fluid intake if your doctor recommends it.
  • Limit how much alcohol you drink.

It is also important to monitor your weight. Rapid weight gain can be a sign of new or worsening HF. So tracking your weight can help you get treatment as soon as you need it. Try to weigh yourself every day at the same time, on the same scale, wearing the same types of clothes. Your doctor may recommend weighing yourself first thing in the morning while wearing minimal clothing.2,10

Call your doctor if you develop any of these signs of worsening HF:2,3,8

  • Increased swelling
  • Weight gain of 2 to 3 pounds in 1 day, or 5 pounds in 1 week

Call 911 if you develop any of the following signs, which can indicate a medical emergency:2,3,8

  • Chest pain
  • Increasing or new shortness of breath
  • Increasing or new cough, especially if you are coughing up blood or mucus
  • Fast or irregular heartbeat

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