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The Vicious Cycle of Chronic Congestive Heart Failure

The Vicious Cycle of Chronic Congestive Heart Failure. Spironolactone. Overflow and Underfilling Hypotheses of Sodium and Water Retention in Cirrhosis. PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS. Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume.

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The Vicious Cycle of Chronic Congestive Heart Failure

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  1. The Vicious Cycle of Chronic Congestive Heart Failure

  2. Spironolactone

  3. Overflow and Underfilling Hypotheses of Sodium and Water Retention in Cirrhosis

  4. PERIPHERAL ARTERIAL VASODILATION HYPOTHESIS Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume COMPENSATED CIRRHOSIS (No Ascites) DECOMPENSATED CIRRHOSIS (Ascites) Hepatorenal Syndrome Normal

  5. Hypothalamic AVP-mRNA of Control and Cirrhotic Rats

  6. “I have ascites and have desire for water, Although I know this water will kill me.” Rami (1226-1294 A.D.)

  7. Effects of Non-Peptide AVP Antagonist in Liver Cirrhosis

  8. Effect of V1-Vasopressin Antagonist on Arterial Blood Pressure in Experimental Cirrhosis in Rats

  9. ALDOSTERONE ANTAGONISM PROMOTES WEIGHT LOSS AND DISAPPEARANCE OF ASCITES IN DECOMPENSATED CIRRHOSIS PARAMETER Death Weight loss (lb) Disappearance of ascites CIRRHOTIC PATIENTS CONTROL (n-22) 7 6 + 2 4 SPIRONOLACTONE (n=21) 5 24 + 4 16 Gregory et al., 1977

  10. Increased Distal Tubular Sodium Delivery with Mannitol Resulted in a Marked Natriuresis During ANP Infusion

  11. Urinary cGMP Increased Significantly During ANP and ANP + Mannitol

  12. Distal Sodium Delivery During Mannitol and ANP + Mannitol in Cirrhotic Patients

  13. Mean Arterial Pressure is Increased by Immersion Plus Norepinephrine but not by Immersion Alone

  14. Effect of Increased Arterial Circulatory Integrity to Normalize Renal Water Excretion in Decompensated Cirrhotic Patients

  15. Correlation Between Increase in Systemic Vascular Resistance and an Increase in Water Excretion in Cirrhotic Patients

  16. Effects of Terlipressin and Albumin on Renal Function in Hepatrorenal Syndrome

  17. Cirrhosis – Arterial Underfilling – Ascites

  18. Effect of Chronic NOS Inhibition on Systemic Vascular Resistance in Cirrhotic Rats with Ascites

  19. Effect of NOS Inhibition for 7 Days on eNOS Protein Expression in Aortas and Mesenteric Arteries in Cirrhotic Rats with Ascites

  20. Effect of Chronic NO Synthesis Inhibition on Aortic cGMP in Cirrhotic Rats with Ascites

  21. Effect of NOS Inhibition for 7 Days on Plasma Arginine Vasopressin and Atrial Natriuretic Peptide in Cirrhotic Rats with Ascites

  22. Effect of NOS Inhibition for 7 Days on Water Excretion in Cirrhotic Rats with Ascites

  23. Effect of NOS Inhibition for 7 Days on Plasma Renin Activity and Aldosterone in Cirrhotic Rats with Ascites

  24. Sodium Excretion is Increased by Chronic L-Name Treatment in Cirrhotic Rats

  25. Changes in Systemic Hemodynamics and Plasma Volume During Pregnancy

  26. Chronic L-NAME Treatment in Day 14 Pregnant Rats Returns Cardiac Output and SVR to Nonpregnant Levels

  27. Chronic L-NAME Treatment in Day 14 Pregnant Rats Returns GFR and RPF to Nonpregnant Levels

  28. Protein Expression of AQP 2 in Pregnancy

  29. Effect of Vehicle and V2 Antagonist on Water Balance in Pregnant Rats

  30. PATHOPHYSIOLOGY OF WATER METABOLISMIN EDEMATOUS DISORDERS CONGESTIVE CARDIAC FAILURE CIRRHOSIS PREGNANCY Nitric Oxide  CARDIAC OUTPUT PERIPHERAL VASODILATION NON-OSMOTIC VASOPRESSIN RELEASE V2 RECEPTOR ANTAGONIST VASOPRESSIN V2 RECEPTOR AQUAPORIN-2 INCREASED WATER PERMEABILITY OF COLLECTING DUCT WATER RETENTION

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