울형성 심부전증에서 심혈관계 보상기전의 지표로서 저나트륨혈증의 의의에 관한 연구 = Significance of Hyponatremia in Patients with Congestive Heart Failure as an Index for the Induction of Circulatory Compensatory Mechanism

다국어 초록 (Multilingual Abstract)

In patient with congestive heart failure, it is well known that the sympatho-adrenal system and the renin angiotensin system are activated to compensate for the reduction of cardiac output and the redistribution of blood flow. Although Lilly, et al. (1984) and Francis, et al. (1985) have insisted that the induction of these circulatory compensation mechanism by pastura1 changes is closely related to the concentration of plama sodium in congestive heart failure, it is still controversial. Thus, in an effort to clarify this hypothesis, present study was designed to determine the relationship between the existing sodium concentration in plasma and the changes of the plasma catecholamine concentration and renin activity during postural alterations in patients with congestive heart fai1ure and normal subjects. Ten patients with congestive heart failure who had been admitted to the Ewha Womans University Hospital from May, 1985 to July, 1985 and five normal volunteers were chosen. Patients with more than one year history of congestive heart failure belonging to class 3 or 4 as the criteria set by the New York Heart Association have been selected for this study. Among these ten patients, 5(3 males and 2 females) had low plasma sodium concentration(below 135mEq/l) and 5(3 males and 2 females) had normal plasma sodium concentration(above 135mEq/l). The observed results are as follows: 1) In the normal subjects, the observed plasma renin activity was 1,2±0.4ng/ml/hr and the concentrations of norepinephrine and epinephrine were 177.5±27 and 150.0±8pg/ml, respectively, at supine position. However, these values were increased by about 2 times by changing to upright position. 2) In patients with hyponatremic congestive heart failure, the values of plasma renin activity and catecholamine levels were significantly higher than those patients having normonatremia. 3) The increase in the plasma renin activity and catecholamin levels induced by upright position were minimal in patients with congestive heart failure having normonatremia. 4) However, in patients with hyponatremic congestive heart failure, the plasma renin activity and the levels of plasma catecholamines were not altered, or rather decreased, by the same postural changes. Based on the results, the levels of plasma sodium concentration in patients with congestive heart failure could provide an index for the induction of circulatory compensation mechaniams and may have important significance in determining the severity and prognosis of the disease. Particularly in the congestive heart failure patients with hyponatremia, as the circulatory compensation mechanism appear to be operating at maximum already, they would not be able to utilize the reflex compensation mechanism inducible with the changes of body position.