Water and Electrolytes in Congestive Failure 273 



filtration rate and increased tubular reabsorption of electro- 

 lytes was also found in patients with left-sided failure and with 

 mitral stenosis without any clinical evidence of right-sided 

 decompensation, the central venous pressure being normal 

 (Fejfar and Brod, 1949; Blegen and Aas, 1950; Werko et al., 

 1952a; Himbert et al, 1954; Werko et al, 1955). 



2 1 



— hps.- 



1 2 



- +hrs. 



Fig. 1. Composite diagram showing percentage changes (A%) 

 in renal blood flow (Clp^n) from the level at hrs (time at which 

 the urine flow began to change) in decompensated cardiacs. 

 In patients with no change in urine flow, hrs was fixed arbi- 

 trarily at 7 p.m. (1) are patients with a nocturnal increase in urine 

 flow, (2) are patients in which the urine flow decreased at night, 

 while in (3) it did not change. See text for details. (Brod, J., 

 and Fejfar, Z. (1950). Quart. J. Med., 19, 187.) 



Fig. 2 presents the individual values of renal blood flow 

 in normal subjects and in patients with heart diseases. All 

 patients are divided into five groups according to the clinical 

 degree of heart failure. 



In the first group are clinically compensated patients. The 

 second group includes patients with a slight to moderate dys- 

 pnoea on effort ; in the third are those with marked dyspnoea 

 on effort, orthopnoea or attacks of nocturnal dyspnoea and 

 acute pulmonary oedema. The fourth group covers patients 

 with signs of right-sided decompensation who responded well 



