Sodium and Water Excretion in Heart Failure: Efficacy of Treatment Has Surpassed Knowledge of Pathophysiology

Excerpt

Fortunately for the patient with congestive heart failure, the effectiveness of treatment has surpassed our understanding of the pathophysiology of the disease. It is possible that the peripheral vasoconstriction and sodium-retentive abnormalities of heart failure are simply manifestations of man's progressive evolutionary move from saltwater to freshwater to land. Those species that have survived such a series of moves have also evolved elaborate systems to defend extracellular fluid and plasma volume.

Vasoconstriction and sodium retention are appropriate responses to loss of circulating volume. In heart failure, the kidney is, in fact, responding to what it perceives as loss of extracellular