Untreated Congestive Heart Failure Studies of Mechanisms

  • I. S. Anand
  • R. Ferrari
  • G. S. Kalra
  • P. L. Wahi
  • P. A. Poole-Wilson
  • P. Harris
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 102)


The mechanisms involved in the accumulation of salt and water in patients with congestive heart failure (CHF) have remained somewhat elusive. There is considerable evidence that neurohormonal responses are altered in patients with heart failure and that some of the alterations may be responsible for this syndrome. 1–4 But the problem with most of the reported studies is that they were made on patients who had received some form of treatment. Treatment in general, and diuretic treatment in particular, has profound effects on hormone levels making it difficult to distinguish between changes induced by disease and those by drug therapy. 1,2,5–7 In some investigations, attempts have been made to examine the syndrome by studying patients from whom drug therapy has been withdrawn for a short duration. Nevertheless, in treated patients one can never be certain as to whether the specific results obtained are attributable to therapy or to the evolution of CHF, or both. There is, therefore, need for data on patients of established CHF who have never received any drug therapy.


Congestive Heart Failure Atrial Natriuretic Peptide Plasma Renin Activity Total Body Water Systemic Arterial Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Laragh JH. Hormones and the pathogenesis of congestive heart failure: vasopressin, aldosterone and angiotensin II. Circulation 1962;25:1015–1023.PubMedGoogle Scholar
  2. 2.
    Genest J, Granger P, De Champlain J, Boucher R. Endocrine factors in congestive heart failure. Am J Cardiol 1968;22:35–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Cohn JN, Levine BT, Francis GS, Goldsmith S. Neurohumoral control mechanisms in congestive heart failure. Am Heart J 1981;102:509–514.PubMedCrossRefGoogle Scholar
  4. 4.
    Packer M. Neurohormonal interactions and adaptations in congestive heart failure. Am Heart J 1988;77:721–730.Google Scholar
  5. 5.
    Nicholls MG, Espiner EA, Hughes H, Roger T. Effect of potassium-sparing diuretics on the renin-angiotensin-aldosterone system and potassium retention on heart failure. Br Heart J 1976;38:1025–1030.PubMedCrossRefGoogle Scholar
  6. 6.
    Ikram H, Chan W, Espiner EA, Nicholls MG. Haemodynamic and hormone responses to acute and chronic frusemide therapy in congestive heart failure. Clin Sci 1980;59:443–449.PubMedGoogle Scholar
  7. 7.
    Bayliss J, Norell M, Canepa-Anson R, Sutton G, Poole-Wilson PA. Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics Br Heart J 1987;57:17–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Anand IS, Veall N, Kalra GS, Ferrari R, Sutton G, Harris P, Poole-Wilson PA. Treatment of heart failure with diuretics: Body fluid compartment, renal function and plasma hormones. Eur Heart J March, 1989. In press.Google Scholar
  9. 9.
    Anand IS, Ferrari R, Kalra GS, Wahi PL, Poole-Wilson PA, Harris P. Edema of cardiac origin: studies of body water, renal functions, hemodynamic and plasma hormones in untreated congestive heart failure. Circulation 1989. In press.Google Scholar
  10. 10.
    Anand IS, Benzing R. A simple automatic gamma counter based upon the IAEA radio-immunoassay instrument. Int J App Radiation and Isotopes 1989;40:89–90.CrossRefGoogle Scholar
  11. 11.
    Ferrari R, Ceconi C, Signorini C, Anand I, Harris P, Albertini A. Sample treatment for long-distance air transport of human plasma for hormone assay. Clinical Chemistry, 1989. In press.Google Scholar
  12. 12.
    Orloff J, Burg MB. The pathogenesis of hyponatremia in congestive heart failure. Prog Cardiovasc Dis 1961;3:600.PubMedCrossRefGoogle Scholar
  13. 13.
    Flear CTG, Crampton RF, Matthews DM. Observations on the electrolyte and water composition of skeletal muscle in patients in congestive cardiac failure using an in vitro method. Clin Sci 1961;21:381.PubMedGoogle Scholar
  14. 14.
    Merrill AJ. 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.CrossRefGoogle Scholar
  15. 15.
    Wade OL, Bishop JM. Cardiac Output and Regional Blood Row. Blackwell, Oxford, 1962.Google Scholar
  16. 16.
    Wanless RB, Anand IS, Poole-Wilson PA, Harris P. An experimental model of chronic cardiac failure using adriamycin in the rabbit: Central haemodynamics and regional blood flow. Cardiovas Res 1987;21:7–13.CrossRefGoogle Scholar
  17. 17.
    Barger AC. The pathogenesis of sodium retention in congestive heart failure. Metabolism 1956;5:480.PubMedGoogle Scholar
  18. 18.
    Bell NH, Schedl HP, Bartter FC. An explanation of abnormal water retention and hypoosmolality in congestive heart failure. Am J Med 1964;36:351.PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson RJ, Cadnapaphornchal P, Harbottle JA, McDonald KM, Schrier RW. Mechanism of effect of thoracic inferior vena cava constriction on renal water excretion. J Clin Invest 1974;54:1473.PubMedCrossRefGoogle Scholar
  20. 20.
    Chidsey CA, Harrison DC, Braunwald E. The augmentation of plasma norepinephrine response to exercise in patients with congestive heart failure. N Engl J Med 1962;267:650.PubMedCrossRefGoogle Scholar
  21. 21.
    Goldstein DS. Plasma norepinephrine as an indicator of sympathetic neural activity in clinical cardiology. Am J Cardiol 1981;48:1147.PubMedCrossRefGoogle Scholar
  22. 22.
    Moskowitz RM, Kinney EL, Zelis RF. Hemodynamic and metabolic responses to upright exercise in patients with congestive heart failure. Chest 1979;76:640.PubMedCrossRefGoogle Scholar
  23. 23.
    Kubo SH, Clark M, Laragh JH, Borer JS, Cody RJ. Identification of neurohumoral activity in mild congestive heart failure and stimulating effect of upright posture and diuretics. Am J Cardiol 1987;60:1322–1328.PubMedCrossRefGoogle Scholar
  24. 24.
    Brown JJ, Davies DL, Johnson VW, Lever AF, Robertson JIS. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart J 1970;80:329.PubMedCrossRefGoogle Scholar
  25. 25.
    Watkins L Jr, Burton JA, Haber E, Cant JR, Smith FW, Barger AC. The renin-angiotensin-aldosterone system in congestive failure in conscious dogs. J Clin Invest 1976:57:1606.PubMedCrossRefGoogle Scholar
  26. 26.
    Hartter E, Weissel M, Stummvoll HK, Wdoszczuk W, Punzengruber C, Ludvik B. Atrial natriuretic peptide concentrations in blood from right atrium in patient with severe right heart failure. Lancet 1985;2:93.PubMedCrossRefGoogle Scholar
  27. 27.
    Petterson A, Hedner J, Hedner T, Held P, Swedberg K, Towle AC. Increased plasma levels of atrial natriuretic peptide in patients with congestive heart failure. Eur Heart J 1986;7:693.Google Scholar
  28. 28.
    Riegger GAJ, Kromer EP, Kochsiek K. Human atrial natriuretic peptide: plasma levels, hemodynamics, hormonal and renal effects in patients with severe congestive heart failure. J Cardiovasc Pharmacol 1986;8:1107.PubMedCrossRefGoogle Scholar
  29. 29.
    Schriffin EL Correlation of left ventricular ejection fraction and plasma atrial natriuretic peptide in congestive heart failure. N Engl J Med 1986;315:765.Google Scholar
  30. 30.
    Ogawa K, Ito T, Hashimoto H, Ito Y, Ohno O, Tsuboi H, Takasu N, Tanahashi T, Satake T. Plasma atrial natriuretic factor in congestive heart failure. Lancet 1986;1:106.PubMedCrossRefGoogle Scholar
  31. 31.
    Maack T, Marion DN, Camargo MJF, Kleinert HD, Laragh JH, Vaughan ED, Atlas SA. Effects of auriculin (atrial natriuretic factor) on the blood pressure, renal function and the renin-aldosterone system in dogs. Am J Med 1984;77:1069.PubMedCrossRefGoogle Scholar
  32. 32a.
    Goldsmith SR, Francis GS, Cowley AW, Levine BT, Cohn JN. Increased plasma arginine vasopressin levels in patients with congestive heart failure. J Am Coll Cardiol 1983;6:1385–90Google Scholar
  33. 32b.
    Goldsmith SR, Francis GS, Cowley AW, Levine BT, Cohn JN. Increased plasma arginine vasopressin levels in patients with congestive heart failure. J Am Coll Cardiol 1983;6:1127–34.Google Scholar
  34. 33.
    Perry WF, Fyles TW. Antidiuretic activity of the serum of normal and diseased subjects. J Clin Endocrinol Metab 1953;13:64.PubMedCrossRefGoogle Scholar
  35. 34.
    Stein M, Schwartz R, Mersky IA. The antidiuretic activity of plasma of patients with hepatic cirrhosis, congestive heart failure, hypertension and other clinical disorders. J Clin Invest 1954;33:77.PubMedCrossRefGoogle Scholar
  36. 35.
    Yamane Y. Plasma ADH levels in patients with congestive failure. Jpn Circ J 1968;32:745.PubMedCrossRefGoogle Scholar
  37. 36.
    Szatalowicz VL, Arnold PE, Chaimovitz C, Bichet D, Berl T, Schrier RW. Radio-immunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure. N Engl J Med 1981;305:263.PubMedCrossRefGoogle Scholar
  38. 37.
    Riegger GAJ, Liebau G, Kochsiek K. Antidiuretic hormone in congestive heart failure. Am J Med 1982;72:49.PubMedCrossRefGoogle Scholar
  39. 38a.
    Schrier RW. Pathogenesis of water and sodium retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy. N Engl J Med 1988;319:1065–1072PubMedCrossRefGoogle Scholar
  40. 38b.
    Schrier RW. Pathogenesis of water and sodium retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy. N Engl J Med 1988;319:1127–1134.PubMedCrossRefGoogle Scholar
  41. 39.
    Nicholls MG, Espiner EA, Donald RA, Hughes H. Aldosterone and its regulation during diuresis in patients with gross congestive heart failure. Clin Sci Mol Med 1974;47:301.PubMedGoogle Scholar
  42. 40.
    Harris P. Congestive cardiac failure: central role of the arterial Wood pressure. Br Heart J 1987;58:190.PubMedCrossRefGoogle Scholar
  43. 41.
    Harris P. Role of arterial pressure in the oedema of heart disease. Lancet 1982;1:477.Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • I. S. Anand
    • 1
    • 2
    • 3
  • R. Ferrari
    • 1
    • 2
    • 3
  • G. S. Kalra
    • 1
    • 2
    • 3
  • P. L. Wahi
    • 1
    • 2
    • 3
  • P. A. Poole-Wilson
    • 1
    • 2
    • 3
  • P. Harris
    • 1
    • 2
    • 3
  1. 1.Postgraduate Institute of Medical Education & ResearchChandigarhIndia
  2. 2.Cattedra di CardiologiaUniversita’ de BresciaBresciaItaly
  3. 3.National Heart & Lung InstituteLondonUK

Personalised recommendations