Body Fluid and Electrolyte Composition in Cardiac Patients with Severe Heart Disease but without Peripheral Edema

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Abstract
Many cardiac patients with severe heart disease appear to handle large oral or intravenous Na loads in a normal manner prior to the development of peripheral edema. The present study was undertaken to determine what abnormalities in body fluid and electrolyte composition occurred in these patients and how the changes observed correlated with cardiovascular and renal hemodynamic function. Measurements of exchangeable body Na and K, extracellular fluid volume, serum osmolarity, serum Na and K and in some instances metabolic balance studies were carried out in 31 non-edematous patients with severe heart disease and matched normal controls. The results indicate that these non-edematous cardiac patients had significant increases in body Na and body K to a new elevated body equibrium state where they were still able to tolerate high dietary Na intakes. The subclinical salt and water retention was demonstrated in the absence of consistent changes in venous pressure, cardiac output, glomerular filtration rate or aldosterone activity but was always associated with increase in pulmonary capillary pressure and reduction in renal plasma flow. The findings suggest that a primary stimulus for salt and water retention in congestive heart failure may involve distention of the pulmonary veins or left atrium.