Clinical and Cardiodynamic Effects of Adrenocortical

Abstract

This study is concerned with the effects of adrenocortical steroids in patients with congestive heart failure. Nine adults with heart failure were studied during a steady clinical state (5 to 7 days), during administration for 13 to 16 days of prednisome (6 patients) or triamcinolone (3 patients) and in some subjects following steroid withdrawal. Daily determinations of fluid balances were made. Standard right heart catheterizations and measurements of blood volumes were performed prior to and at the termination of therapy. Three types of responses to steroids occurred. In 5 patients increases in subjective and objective manifestations of heart failure and increased fluid retention occurred. Four of them developed precarious clinical conditions during steroid therapy, requiring mercurial diuretics, but with poor results. In general, cardiodynamic status at the termination of steroid therapy correlated well with clinical status. In 3 patients the clinical status did not change. Some depression in urinary sodium and chloride excretions were noted during therapy. Cardiodynamics were unaltered, except for an unexplained decrease in right ventricular end-diastolic pressure in 1 patient. In 1 patient clinical and cardiodynamic state improved, despite positive fluid balance. This was the only subject with primary lung disease (emphysema) and cor pulmonale. These studies suggest that corticosteroids are generally detrimental in uncomplicated congestive heart failure. Greater deterioration appeared in subjects having the more severe degrees of decompensation, suggesting that exogenous fluid-retaining influences were added to endogenous fluid-retaining forces, resulting in further accumulation of fluid in a circulatory system already burdened by hypervolemia.