The relation of emotional state to renal excretion of water and electrolytes in patients with congestive heart failure

Abstract

Eight male patients with compensated congestive heart failure (and stabilized as to weight) were studied on a metabolic ward. Sodium and water intake was maintained constant. All urine was collected, the volume noted, and sodium and potassium excretion measured. These data were kept completely separate from a daily appraisal of the behavior, attitudes and emotional state of the subject. The contribution of the position of the body and muscular activity to the excretory pattern was also controlled and evaluated. Wide fluctuations in renal excretion of fluid and electrolytes were observed in all patients; these fluctuations could be correlated with attitudes and emotions. In situations which evoked feelings of discouragement or tension, renal excretion of water and sodium was decreased. The decrease in volume was often not proportionate to the marked retention of sodium, perhaps due to an increase in antidiuretic hormone in advanced congestive failure. In situations which evoked a reaction of excitement, anger or apprehension, renal excretion rates of sodium were increased as compared with excretion rates observed during neutral periods. A diuresis of sodium and water was also associated with periods of reassurance and active relaxation. Such alterations in excretory pattern related to the emotional state of the patient were sometimes greater than those attributable to body position or muscular activity. There was no significant variation in potassium excretion which could be correlated with a specific emotional state. The findings suggest that in the patient with decreased cardiac reserve prolonged states of tension or depression may be a precipitating factor for an episode of decompensation by the mechanism of fluid and sodium retention. A reassuring attitude on the part of the physician may be of substantial importance in the therapy of congestive heart failure.