edema and other symptoms

[Rob2008]

I was not too sure where to turn with this question, since I've seen that edema can have many causes.  Allow me to describe my symptoms.  About a year and a half ago, I started having skipped heartbeats with no history of such, odd lightheaded episodes (even during a normal rate and rhythm), chronic atypical chest tightness, and during certain times, shortness on breath and quick fatigue even with slight exertion.  I had a 30 day heart monitor on and nothing showed up during all these symptoms, just the extra beats.    I remember all along my ankles felt very stiff but I didn't realize anything until I started looking at things and noticed that I have pitting edema in both legs.  It is mild, relatively, but it is certainly there and doesn't ever go away.  Leg symptoms are mostly stiffness with occasional very mild cramping.  To be fair, I did gain perhaps 30 pounds in the year before all this began and I now weigh 275 and I'm 5'10.   I also must admit that since I started 30 mins of exercise per day, my symptoms have somewhat improved, but the edema has not improved.

Tests I've had are stress test, echo (separately), CTX, EKG
Labs:  Cbc, CMP, Liver, TSH, T4, BNP, clotting tests, Lipids, ABG, my ESR is always 0

Bottom line, in my mind I wonder if the edema is causing poor blood flow to my heart and causing the other symptoms?
Have we covered all possible non-CVI causes? Must I have an ultrasound of the legs to prove this is just CVI?  Is my answer really as simple as losing 75 lbs? Would the edema probably go away then?  Could this indicate some systemic vascular problem?
Thank you so much

[limie211]

That was a clear explanation by the Jewish Group. I am pretty sure, you had a blood test as well. How was the result? How about potassium , and other electrolytes? For the meantime that you will be getting some diagnostic tests again, try this simple tips..place 2-3 pillows under your legs when you get home and if you are in office, raise your legs; make it a habit to drink hot green tea or sambong tea everyday and more fruits.

[National Jewish Health]

Edema can occur on the basis of heart disease, liver disease, kidney disease, and chronic venous insufficiency, with or without deep vein thrombosis.  The venous insufficiency can be aggravated by obesity and sitting for long stretches of time, relatively immobile with your feet on the floor.  However, the symptoms you describe, “chronic atypical chest tightness, and during certain times, shortness on breath and quick fatigue even with slight exertion.  I had a 30 day heart monitor on and nothing showed up during all these symptoms, just the extra beats”, suggest the possibility of deep vein thrombosis and, even more worrisome, the possibility of pulmonary emboli, which are clots, from the deep leg veins, to your lungs.

A rapid heart beat and near-syncope, with squatting, results from reduced blood flow from the legs, back to your heart.  This is a normal physiologic response but becomes exaggerated with obesity or with any impairment of venous blood flow from the legs, such as venous insufficiency and/or venous obstruction.

And so, yes, you should have a doppler study of the deep veins of your legs and, if there is no sign of clots in your leg veins, should have a CT scan of the pelvis and abdomen to rule out something compressing the inferior vena cava along with a lung scan or CT scan of the chest to detect pulmonary emboli, which are clots in the lungs.

If all is normal or negative, you should then have further evaluation of your heart, kidneys and liver.

Good luck.

[Rob2008]

One more thing I thought was unusual... When I squat down or after I stretch my legs, I become very lightheaded often times for a while.   Sometimes when I squat down my heart starts pounding very hard and I get near syncope