August 1, 1989Circulation
Edema of cardiac origin. Studies of body water and sodium, renal function, hemodynamic indexes, and plasma hormones in untreated congestive cardiac failure.
Population
8 patients with severe clinical congestive cardiac failure who had never received therapy and had…
Design
Case_series
Authors
Discussion
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Implication
Alerts to extreme derangements possible in untreated HF; hypothesis-generating case report leaves applicability to treated patients open.
Key Points
- Quantify alterations in body water, sodium balance, renal function, hemodynamics, and plasma hormone levels in patients with untreated severe congestive cardiac failure.
- Evaluated 8 untreated patients presenting with severe clinical congestive cardiac failure (N=8; 2 ischemic cardiac disease, 6 dilated cardiomyopathy).
- Measured resting hemodynamic parameters, fluid volumes, total exchangeable sodium, renal plasma flow, glomerular filtration rate, and plasma hormone concentrations relative to control values.
- Hemodynamic and fluid indices showed reduced resting cardiac index (1.8 l/min/m2), elevated pulmonary wedge pressure (30 mm Hg), marked renal impairment (renal plasma flow 29% and glomerular filtration rate 65% of control), and increases in extracellular liquid (+33%) and total exchangeable sodium (+37%).
- Neurohormonal profiling revealed substantial increases above normal in atrial natriuretic peptide (14.3-fold), growth hormone (11.5-fold), plasma renin activity (9.5-fold), aldosterone (6.4-fold), norepinephrine (6.3-fold), and cortisol (1.7-fold), while adrenaline was unaffected and vasopressin rose in only one patient.
Structured PICO
P
Population
8 patients with severe clinical congestive cardiac failure who had never received therapy and had established accumulation of excess water and sodium (2 with ischemic cardiac disease, 6 with dilated cardiomyopathy).
C
Comparator
Healthy controls (implied by comparisons to 'control' values).
O
Outcome
Plasma hormone levels, body water and sodium content, renal function, and hemodynamic indexes.surrogate
This study characterizes the profound neurohormonal activation, fluid retention, and hemodynamic derangements present in severe, untreated congestive heart failure.
Cite This Study
Anand et al. (1989) studied this question.