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 COMPENSATED CIRRHOSIS (No Ascites) Peripheral Arterial Vasodilation Plasma Hormones (AVP, Renin, Aldosterone, NE) Plasma Volume Normal DECOMPENSATED CIRRHOSIS (Ascites) Hepatorenal Syndrome

Hypothalamic AVP-m. RNA of Control and Cirrhotic Rats

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

Effects of Non-Peptide AVP Antagonist in Liver Cirrhosis

Effect of V 1 -Vasopressin Antagonist on Arterial Blood Pressure in Experimental Cirrhosis in Rats

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

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

Urinary c. GMP Increased Significantly During ANP and ANP + Mannitol

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

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

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

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

Effects of Terlipressin and Albumin on Renal Function in Hepatrorenal Syndrome

Cirrhosis – Arterial Underfilling – Ascites

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

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

Effect of Chronic NO Synthesis Inhibition on Aortic c. GMP in Cirrhotic Rats with Ascites

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

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

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

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

Changes in Systemic Hemodynamic s and Plasma Volume During Pregnancy

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

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

Protein Expression of AQP 2 in Pregnancy

Effect of Vehicle and V 2 Antagonist on Water Balance in Pregnant Rats

PATHOPHYSIOLOGY OF WATER METABOLISM IN EDEMATOUS DISORDERS CONGESTIVE CARDIAC FAILURE CIRRHOSIS PREGNANCY Nitric Oxide CARDIAC OUTPUT PERIPHERAL VASODILATION V 2 RECEPTOR ANTAGONIST NON-OSMOTIC VASOPRESSIN RELEASE VASOPRESSIN V 2 RECEPTOR AQUAPORIN-2 INCREASED WATER PERMEABILITY OF COLLECTING DUCT WATER RETENTION