Fluid overload contributing to heart failure
Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel
Correspondence and offprint requests to: Avraham Shotan, MD, Heart Institute, Hillel Yaffe Medical Center, Hadera, 38100, Israel. Email: shotana{at}yahoo.com
Background. In advanced heart failure, the compensatory responses to reduced cardiac output, in spite of fluid retention, lead to maladaptive consequences.
Methods. We performed a Medline survey for fluid overload and heart failure as well as reviewing textbook chapters.
Results. The increased sympathetic nervous system, renin–angiotensin–aldosterone system, and antidiuretic hormone stimulation and release lead to a vicious cycle—augmenting pre-load, contractility and after-load, as well as increased fluid overload. The elevated work load on an already failed cardio-circulatory system results in further deterioration. Plasma volume is usually increased in untreated patients with increased extracellular fluid. However, it may range from reduced to increased in treated patients. Currently, diuretics remain the initial first line of therapy. In refractory cases, restoring plasma volume and osmolality, by adding albumin or hypertonic saline solutions, neurohormonal antagonists such as vasopressin receptors antagonists, aldosterone antagonists, or administration of nesiritide, may help in overcoming fluid overload.
Conclusion. Exact measurement of plasma volume in various forms of heart failure and adjusting the treatment accordingly, establishing favourable and detrimental effects of various therapies, and introducing additional and new therapeutic options require further investigation.
Keywords: fluid overload; heart failure; neurohormonal activation