Edema of cardiac origin. Studies of body water and sodium, renal function, hemodynamic indexes, and plasma hormones in untreated congestive cardiac failure.

Abstract

This study provides data on plasma hormone levels in patients with severe clinical congestive cardiac failure who had never received therapy and in whom the presence of an accumulation of excess water and sodium had been established. Eight patients were studied; two had ischemic cardiac disease, and six had dilated cardiomyopathy. Mean hemodynamic measurements at rest were as follows: cardiac index, 1.8 1/min/m2; pulmonary wedge pressure, 30 mm Hg; right atrial pressure, 15 mm Hg. Total body water content was 16% above control, extracellular liquid was 33% above control, plasma volume was 34% above control, total exchangeable sodium was 37% above control, renal plasma flow was 29% of control, and glomerular filtration rate was 65% of control. Plasma norepinephrine was consistently increased (on average 6.3 times control), whereas adrenaline was unaffected. Although plasma renin activity and aldosterone varied widely, they were on average above normal (renin 9.5 times control, aldosterone 6.4 times control). Plasma atrial natriuretic peptide (14.3 times control) and growth hormone (11.5 times control) were consistently increased. Cortisol was also increased on average (1.7 times control). Vasopressin was increased only in one patient. (Circulation 1989;80:299-305)

Heart failure ketosis

“…In theory, CHF could lead to accelerated ketogenesis by a number of mechanisms. First, neuroendocrine activation is common [1,13] and was seen in our study group as elevated concentrations of noradrenaline, cortisol and growth hormone in the circulation. All these hormones promote ketogenesis by increasing the supply of free fatty acids through a lipolytic action which is particularly prominent if the antilipolytic effect of insulin is blunted [14][15][16][17][18][19].…”

Adaptive Servo-Ventilation Therapy Improves Long-Term Prognosis in Heart Failure Patients With Anemia and Sleep-Disordered Breathing

“…22) Salt and water retention increase plasma and extracellular volume, progressing to LV remodeling and dysfunction, and worsening heart failure. 22,23) Hemoglobin content in blood is an important determinant of oxygen delivery to skeletal muscle during exercise. Patients with CHF lack the normal physiological reserve to compensate for decreased hemoglobin and may manifest decreased aerobic capacity in response to mild degrees of anemia.…”

Iron Metabolism, Iron Deficiency, Thrombocytosis, and the Cardiorenal Anemia Syndrome

“…Comparing nonanemic CHF patients with people who are anemic (because of iron deficiency or blood loss) but not in heart failure shows an intriguing pattern of similarities and differences [56,57]. Relative to relevant controls, nonanemic CHF patients show substantially greater systemic vascular resistance, because these patients by definition have reduced cardiac output.…”

“…Correction of anemia by blood transfusion returns all these parameters to normal [56]. Hence, anemia per se is associated with many of the same pathophysiological changes that are seen in heart failure [56,57]. It is therefore not surprising that it has an independently damaging effect.…”