A 62-year-old man presents to the office for assessment of symptoms of shortness of breath. The symptoms are worse with exertion and he notes difficulty lying down. He reports no chest pain or palpitations but his feet are swollen. His past medical history includes hypertension and type 2 diabetes, for which he is taking ramipril, amlodipine, and metformin.On physical examination, the blood pressure is 125/84 mm Hg, heart rate is 100/min. The jugular venous pressure is 8 cm above the sternal angle, with a third heart sound, pedal edema, and bibasilar crackles on auscultation of the lungs. Which one of the following may be implicated in fluid retention for this condition?
Aldosterone, renin, and vasopressin are generally increased in heart failure. Retention of fluid is complex and not due to any one factor; however, hormones may contribute. Growth hormone does not have fluid-retaining properties. The exact mechanisms that initiate renal conservation of salt and water are not precisely understood, but may include arterial volume receptors sensing a decrease in the effective arterial blood volume that occurs in heart failure.
decreased renin
increased aldosterone
increased estrogen
increased growth hormone
C.V.S.