Sodium and Water Excretion in Heart Failure: Efficacy of Treatment Has Surpassed Knowledge of Pathophysiology
Authors: GARY S. FRANCIS
Journal: Annals of Internal Medicine (1986)

Editorials1 August 1986Sodium and Water Excretion in Heart Failure: Efficacy of Treatment Has Surpassed Knowledge of PathophysiologyGARY S. FRANCIS, M.D.GARY S. FRANCIS, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-2-272 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptFortunately for the patient with congestive heart failure, the effectiveness of treatment has surpassed our understanding of the pathophysiology of the disease. It is possible that the peripheral vasoconstriction and sodium-retentive abnormalities of heart failure are simply manifestations of man's progressive evolutionary move from saltwater to freshwater to land. Those species that have survived such a series of moves have also evolved elaborate systems to defend extracellular fluid and plasma volume.Vasoconstriction and sodium retention are appropriate responses to loss of circulating volume. In heart failure, the kidney is, in fact, responding to what it perceives as loss of extracellular...References1. DZAUCOLUCCIHOLLENBERGWILLIAMS VWNG. Relation of the renin-angiotensin-aldosterone system to clinical state in congestive heart failure. Circulation. 1981;63:645-51. CrossrefMedlineGoogle Scholar2. GOLDSMITHFRANCISCOWLEYLEVINECOHN SGATJ. Increased plasma arginine vasopressin levels in patients with congestive heart failure. J Am Coll Cardiol. 1983;1:1385-90. CrossrefMedlineGoogle Scholar3. BARGERROSSPRICE ARH. Reduced sodium excretion in dogs with mild valvular lesions of the heart, and in dogs with congestive heart failure. Am J Physiol. 1955;180:249-60. CrossrefMedlineGoogle Scholar4. CHOBANIANBURROWSHOLLANDER ABW. Body fluid and electrolyte composition in cardiac patients with severe heart disease but without peripheral edema. Circulation. 1961;24:743-53. CrossrefMedlineGoogle Scholar5. HOSTETTERPFEFFERPFEFFERDWORKINBRAUNWALDBRENNER TJMLEB. Cardiorenal hemodynamics and sodium excretion in rats with myocardial infarction. Am J Physiol. 1983;245:H98-103. MedlineGoogle Scholar6. GOETZBENDBLOXHAM KGD. Atrial receptors and renal function. Physiol Rev. 1975;55:157-205. CrossrefMedlineGoogle Scholar7. THAMESKLOPFENSTEINABBOUDMARKWALKER MHFAJ. Preferential distribution of inhibitory cardiac receptors with vagal afferents to the inferoposterior wall of the left ventricle activated during coronary occlusion in the dog. Circ Res. 1978;43:512-9. CrossrefMedlineGoogle Scholar8. MIGDALALEXANDERLEVINSKY SEN. Evidence that decreased cardiac output is not the stimulus to sodium retention during acute constriction of the vena cava. J Lab Clin Med. 1977;89:809-16. MedlineGoogle Scholar9. HOLLENBERGSCHULMAN NG. Renal perfusion and function in sodium-retaining states. In: SELDIN DW, GIEBISCH GH, eds. The Kidney: Physiology and Pathophysiology. New York: Raven Press; 1985:1119-36. Google Scholar10. MERRILL A. Edema and decreased renal blood flow in patients with chronic congestive heart failure: evidence of "forward failure" as the primary cause of edema. J Clin Invest. 1946;25:389-400. CrossrefGoogle Scholar11. BRODFEJFARFEJFAROVA JZM. The role of neurohumoral factors in the genesis of renal hemodynamic changes in heart failure. Acta Med Scand. 1954;148:273-90. CrossrefMedlineGoogle Scholar12. DZAUCOLUCCIWILLIAMSCURFMANMEGGSHOLLENBERG VWGGLN Sustained effectiveness of converting-enzyme inhibition in patients with severe congestive heart failure. N Engl J Med. 1980;302:1373-9. CrossrefMedlineGoogle Scholar13. METTAUERROULEAUBICHET BJD. Sodium and water excretion abnormalities in congestive heart failure: determinant factors and clinical implications. Ann Intern Med. 1986;105:161-7. LinkGoogle Scholar14. WEISSELLIS SL. Circulatory measurements in patients with rheumatic heart disease before and after the administration of digitalis. J Clin Invest. 1930;8:435-65. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GARY S. FRANCIS, M.D.Affiliations: Veterans Administration Medical Center and the University of Minnesota Medical School Minneapolis, Minnesota PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byStörungen des Wasser-, Elektrolyt-und Säure-Basen-HaushaltsSustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: Failure of furosemide to provide the same resultStörungen des Wasser-, Elektrolyt- und Säure-Basen-HaushaltsCongestive Heart FailureSodium depletion increases calcium-activated left ventricular pressure in the rat.Chronic Sodium Depletion Increases Myocardial Calcium Content in Normotensive RatsCurrent therapeutic principles in the acute management of severe congestive heart failure 1 August 1986Volume 105, Issue 2Page: 272-274KeywordsExcretionHeart diseasesHeart failurePlasma volumeRenal failureSodiumVasoconstriction ePublished: 1 December 2008 Issue Published: 1 August 1986 PDF downloadLoading ...