Acid–base and electrolyte abnormalities in heart failure: pathophysiology and implications

Abstract

Electrolyte and acid–base abnormalities are a frequent and potentially dangerous complication in subjects with congestive heart failure. This may be due either to the pathophysiological alterations present in the heart failure state leading to neurohumoral activation (stimulation of the renin–angiotensin–aldosterone system, sympathoadrenergic stimulation), or to the adverse events of therapy with diuretics, cardiac glycosides, and ACE inhibitors. Subjects with heart failure may show hyponatremia, magnesium, and potassium deficiencies; the latter two play a pivotal role in the development of cardiac arrhythmias. The early identification of these alterations and the knowledge of the pathophysiological mechanisms are very useful for the management of these patients.

Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance

“…Metabolic alkalosis is the most common acid–base disturbance in patients with heart failure, and chloride depletion in the context of alkalosis is a well‐recognised complication of diuretic treatment …”

Relationship between plasma volume and essential blood constituents in patients with heart failure and preserved ejection fraction

“…Changes in electrolyte concentration may induce alterations in neurological function, skeletal muscle and cardiac contraction, among other potentially precipitating life-threatening events (Goldstein, 1990;Viera & Wouk, 2015;Ellison et al, 2016). mineralocorticoids, thiazide/loop diuretics, angiotensin-converting-enzyme inhibitor and angiotensin II receptor blockers) (Urso et al, 2015). In cardiovascular diseases such as HF, electrolyte imbalances are frequently encountered and related to the excessive activation of the renin-angiotensin-aldosterone system as well as the use of specific medications (e.g.…”

“…Routine tests for the assessment of electrolyte abnormalities rely on circulating levels, which generally reflect their average extracellular concentration (Cleland et al, 1985). The most common electrolyte disturbances in HF patients are hyponatremia, hypokalemia and hypomagnesemia (Urso et al, 2015). mineralocorticoids, thiazide/loop diuretics, angiotensin-converting-enzyme inhibitor and angiotensin II receptor blockers) (Urso et al, 2015).…”

The Metabolic Effects of Mineralocorticoid Receptor Antagonists in Heart Failure Patients

“…Elevated circulating aldosterone has found in patients with asymptomatic and symptomatic HF developed due ischemic and none ischemic causes [15]. Therefore, the pivotal role of aldosterone was found in cardiomyopathies, hypertension, atrial fibrillation, myocardial infarction / acute coronary syndrome, and dysmetabolic states, i.e.…”