CLINICAL STUDIES ON THE ROLE OF ALDOSTERONE CONCERNING THE EDEMA FORMA.TION IN CHRONIC CONGESTIVE HEART FAILURE

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概要

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• 1. Urinary excretion of aldosterone in the patients with congestive heart failure prior to drug therapy was increased in 23 out of all 45 determinations under the constant diet containing daily 85mEq of Na and 60mEq of K. The increase in urinary aldosterone was seen most frequently in the cases with right-sided or both-sided heart failure, especially with large quantity of edema fluid. But in those with spontaneous diuresis at rest or in the state of so-called "de-crescendo decompensation", aldosterone excretion was within normal range. All but one cases of left-sided heart failure gave normal values. 2. There was an inverse correlation between amount of urinary excretion of aldosterone prior to medication and daily urinary Na excretion or urinary Na/K ratio, respectively. No correlation was found between urinary aldosterone and the severity of heart failure, venous pressure, renal function and any serum electrolytes. 3. Almost inversed correlation was found between urinary aldosterone and 17-OHCS. In the cases with high aldosterone values, urinary 1 7-OHCS excretion was low in general. 4. Improvement of cardiac function through bed rest and/or the action of digitalis led to gradual decrease in aldosterone excretion. In the cases with advanced edema or ascites and high venous pressure, prompt diuresis through the administration of thiazide diuretics or triamterene caused a transient decrease in aldosterone excretion and later increase concomitant with decrease in serum Na level, urinary Na and water excretion. This was considered as a "rebound phenomenon". 5. When forced diuresis was ensued in two severe cases with repeated congestive heart failure, using powerful diuretics for a long period, showing the state of artificial hyperaldosteronism, the regulation system finally might break, leading to a decrease in aldosterone excretion despite of hyponatremia and of decrease in urinary Na and water excretion. Glucocorticoid excretion also decreased. The living organism may lose its ability for adaptation and probably thus fall living in refractory heart failure. Based on the above results, the role of aldosterone in the pathogenesis of cardiac edema was discussed.

• 社団法人日本循環器学会の論文
• 1971-11-20

著者

• Kubo Shinichiro

  The 3rd Division. Department Of Internal Medicine Faculty Of Medicine Kyoto University

• Kubo Shinichiro

  The 3rd Division Department Of Internal Medicine Faculty Of Medicine Kyoto University

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• CLINICAL STUDIES ON THE ROLE OF ALDOSTERONE CONCERNING THE EDEMA FORMA.TION IN CHRONIC CONGESTIVE HEART FAILURE

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