A 67-year-old male was diagnosed with acute heart failure based on the clinical findings of decreased cardiac output, pulmonary congestion, and peripheral edema. His increased creatinine and BUN also indicated renal insufficiency. His electrocardiogram shows evidence of old myocardial infarction. Echocardiography reveals diminished left ventricular ejection fraction without ventricular dilatation. Pharmacologic therapy is started, including a positive inotrope, a coronary vasodilator, an antihypertensive ACE inhibitor, and a loop diuretic. Elective coronary angiography reveals significant stenosis of the left anterior descending artery. He undergoes balloon angioplasty and stent placement and remains stable as an outpatient. His discharge drug regimen is accompanied by a low-salt, low fat diet. What mechanisms led to Mr. R’s pulmonary congestion and pedal edema? How are they related to renal function and fluid-electrolyte balance? Briefly describe the process of sodium and fluid retention and involvement of renin-angiotensin-aldosterone system.
A 67-year-old male was diagnosed with acute heart failure based on the clinical findings of decreased cardiac output, pulmonary congestion, and peripheral edema. His increased creatinine and BUN also indicated renal insufficiency. His electrocardiogram shows evidence of old myocardial infarction. Echocardiography reveals diminished left ventricular ejection fraction without ventricular dilatation. Pharmacologic therapy is started, including a positive inotrope, a coronary vasodilator, an antihypertensive ACE inhibitor, and a loop diuretic. Elective coronary angiography reveals significant stenosis of the left anterior descending artery. He undergoes balloon angioplasty and stent placement and remains stable as an outpatient. His discharge drug regimen is accompanied by a low-salt, low fat diet.
- What mechanisms led to Mr. R’s pulmonary congestion and pedal edema? How are they related to renal function and fluid-electrolyte balance?
- Briefly describe the process of sodium and fluid retention and involvement of renin-angiotensin-aldosterone system.
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