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European Heart Journal 1989 10(12):1075-1083;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Neuroendocrine response in acute heart failure and the influence of treatment

M. BROQVIST*, U. DAHLSTRÖM*, B. E. KARLBERG{dagger}, E. KARLSSON* and T. MARKLUND{ddagger}

*Division of Cardiology, Department of Medicine, University of Health Sciences Linköping, Sweden
{dagger}Division of Endocrinology, Department of Medicine, University of Health Sciences Linköping, Sweden
{ddagger}Department of Radiology, University of Health Sciences Linköping, Sweden

Received 3 October 1988; revised 14 April 1989; .

Address for correspondence: Mats Broqvist, MD, Division of Cardiology, Department of Medicine, University Hospital, S-58185 Linküoping, Sweden

Abstract

Vasoactive humoral factors were measured in 27 patients before and during the first week of conventional treatment of acute heart failure. On admission, all patients were given frusemide intravenously, followed by oral digoxin and diuretic therapy. Before drug treatment, plasma renin activity and plasma angiotensin II concentrations were within normal ranges in the group of patients without previous diuretic treatment, but were significantly higher in those 16 patients already on diuretic drugs when admitted to hospital. After diuretic treatment, however, even the former group revealed activation of the renin-angiotensin system.

Plasma concentrations of catecholamines were increased initially but normalized within 1 day. A majority of the patients initially had very high plasma concentrations of atrial natriuretic peptide (mean 276.9 ± 39.0 pg ml–1) which decreased but did not normalize during the study period. High plasma levels of arginine vasopressin (mean 56.8 ± 14.6 pg ml–1) were found, but tended to be reduced during treatment.

Thus, patients with acute heart failure displayed increased plasma concentrations of atrial natriuretic peptide, arginine vasopressin and catecholamines, but these vasoactive hormones decreased in parallel to clinical improvement during diuretic therapy. In contrast, the renin-angiotensin system became clearly activated.

Key Words: Arginine vasopressin • atrial natriuretic peptide • cyclic GMP • heart failure • norepineph-rine • renin-angiotensin system • treatment


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