“Idiopathic” edema resulting from occult cardiomyopathy

Abstract

The effects of treatment with desoxycorticosterone acetate (DOCA), 20 mg. per day, before and during treatment with digoxin, and of adrenergic blockade with guanethidine were determined in a twenty-six year old woman with idiopathic edema. On a sodium intake of 250 mEq. per day, treatment with DOCA for twelve days produced sodium retention and weight gain and these changes were greater than those usually seen in normal subjects. Treatment with guanethidine caused marked sodium retention, weight gain and an increase in venous pressure. Values for creatinine clearance and aldosterone excretion were within the normal range, and were not changed by treatment with guanethidine. At cardiac catheterization, the ventricular end-diastolic pressures were increased and the response of left ventricular stroke work to exercise and to an infusion of angiotensin was subnormal, suggesting a diagnosis of cardiomyopathy. Edema disappeared upon treatment with digoxin. On a sodium intake of 250 mEq. per day, treatment with DOCA caused sodium retention and weight gain for only six days. These latter changes were comparable to those seen in normal subjects. The studies suggest that occult heart disease may be a cause for the syndrome of “idiopathic” edema, and that adrenergic blockade may be useful for the detection of latent impairment of cardiac function.