Figure 229

Mechanism of extracellular fluid (ECF) volume expansion in congestive heart failure. A primary decrease in cardiac output (indicated by dark blue arrow) leads to a decrease in arterial pressure, which decreases pressure natriuresis and volume excretion. These decreases expand the ECF volume. The inset graph shows that the ratio of interstitial volume (solid line) to plasma volume (dotted line) increases as the ECF volume expands because the interstitial compliance increases [62]. Thus, although expansion of the ECF volume increases blood volume and venous return, thereby restoring cardiac output toward normal, this occurs at the expense of a disproportionate expansion of interstitial volume, often manifested as edema.

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