Reviewed by: HU Medical Review Board | Last reviewed: November 2021

People with chronic obstructive pulmonary disease (COPD) may have swelling in their ankles, legs, and feet. This kind of swelling is not caused directly by COPD. However, there are complications of COPD that can cause swelling. These conditions are called pulmonary hypertension and cor pulmonale.1

What is pulmonary hypertension?

Our heart has 2 sides with different jobs. First, the right side pumps blood into the lungs. In the lungs, millions of tiny air sacs transfer oxygen into the blood. This blood flows back to the left side of the heart. From here it is pumped to the rest of the body.2

Pulmonary hypertension is the name for high blood pressure in the blood vessels (arteries) in the lungs. When these arteries become narrow or damaged, blood cannot flow through them as easily. In turn, the pressure inside them increases. If this happens, the right side of the heart must work harder to move the blood through the lungs.2

What is cor pulmonale?

If the right side of the heart continues to have to work hard to pump blood, it can lead to permanent damage. Cor pulmonale is the name for the enlargement and failure of the right side of the heart.3

How do pulmonary hypertension and cor pulmonale cause swelling?

If the heart is not working efficiently, it can cause fluid buildup in the ankles, legs, and feet. This leads to swelling, which is sometimes called edema. Symptoms of edema can include:4

  • Difficulty walking
  • Pain or discomfort in the swollen area
  • Increased risk of infection in the swollen area

How does COPD lead to pulmonary hypertension and cor pulmonale?

People with COPD often get pulmonary hypertension or cor pulmonale because of lung damage caused by COPD. This lung damage can lead to not having enough oxygen in the bloodstream. This can make the blood vessels become too narrow. COPD can also destroy the blood vessels that surround the tiny air sacs in the lungs where oxygen is absorbed.1

Both these effects of COPD can cause pulmonary hypertension. This is because the heart must work harder to push blood through narrower and fewer blood vessels. If pulmonary hypertension is not treated and gets worse, it can cause cor pulmonale.1

Pulmonary hypertension and cor pulmonale are complications anyone with COPD can have. But they become more common in the later stages of the disease.1

Symptoms of pulmonary hypertension or cor pulmonale besides swelling include:2

Can swelling be treated?

If you have COPD, contact your doctor if you notice swelling in your ankles, legs, or feet. It is important to treat pulmonary hypertension before it leads to cor pulmonale. Cor pulmonale can be a very harmful and life-threatening condition.2

Swelling is treated by addressing the conditions that cause it. There is no cure for pulmonary hypertension, but it can be managed to prevent more serious conditions. There are certain types of medicines that can help to:2

  • Reduce swelling in the ankles, legs, and feet
  • Help the heart beat more strongly
  • Thin the blood and reduce the risk of blood clots

Pulmonary hypertension and cor pulmonale can be treated with supplemental oxygen (oxygen therapy) if blood oxygen is low enough to qualify for this therapy. This can increase the level of oxygen in the blood.2

During oxygen therapy, oxygen is delivered through a soft tube that fits into the nostrils or through a mask over the mouth and nose. This treatment is not for everyone. Your treatment may be different. Talk to your doctor about your choices and which treatment is best for you.2

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