"Apparent" heart failure: a syndrome caused by renal artery stenoses

doi:10.1136/heart.83.2.152

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Heart 2000;83:152-155; doi:10.1136/heart.83.2.152

Heart 2000;83:152-155 ( February )

Cardiovascular medicine

"Apparent" heart failure: a syndrome caused by renal artery stenoses C G Missouris, A-M Belli, G A MacGregor

St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK

Correspondence to: Dr Missouris

Accepted 16 September 1999

OBJECTIVE $---$ To report on renal artery stenosis presenting as congestive heartfailure.
DESIGN $---$ Caseseries.
SETTING $---$ Tertiary referralcentre.
PATIENTS $---$ Nine hypertensive subjects (five male, four female) seen in the blood pressure unit, St George's Hospital, between 1991 and1997 with clinical signs and symptoms of congestive cardiac failurebut without overt coronary or valvar heart disease. Mean (SEM)age was 67 (3) years. Eight patients had renal artery revascularisationwith percutaneous angioplasty and one hadsurgery.
RESULTS $---$ Renal revascularisation was followed by a large fall in blood pressure from 191/94 (7/3) to 150/75 (8/5) mm Hg two days afterintervention (p < 0.01). There was also a large natriuresis andweight reduction. One week after revascularisation there was amean loss in weight of 3.8 (0.6) kg. The largest fall in weightwas seen in those patients with stenosis in a single functioningkidney. Furthermore, plasma atrial natriuretic factor fell from120 (28) to 48 (9) pg/ml (p < 0.05; n = 6; normal value = 8.6(0.8) pg/ml), and serum creatinine fell from 200 (37) to 140 (11)µmol/l (p < 0.025). The clinical signs and symptoms of heart failureresolved and the diuretics were then withdrawn in all patients.On long term follow up, patients remained free from symptoms andsigns of heart failure and the blood pressure was bettercontrolled.
CONCLUSIONS $---$ In hypertensive patients with symptoms and signs of congestive heart failure who do not have obvious ischaemic or valvar heartdisease, renal artery stenosis should be considered as a possibleunderlying cause. Relief of the stenosis can result in resolutionof the apparent heartfailure.

Keywords: renal artery stenosis; heart failure

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