Sodium and CHF

Q: Hyponatremia in congestive heart failure (CHF) parallel the severity of the heart failure?

A) True

B) False

Answer: If hyponatremia occurs solely due to CHF, studies have shown that the patient survival is significantly decreased below serum sodium of 137 mEq/L. Moreover, it is almost considered end-stage once it crosses below 125 mEq/L. 

Unfortunately, hyponatremia is not only a poor prognostic in long-term CHF but also in patients who get admitted to the hospital with an exacerbation of CHF. It correlates with mortality in-hospital and 30-days.

#cardiology

References: 

1. Goldberg A, Hammerman H, Petcherski S, et al. Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med 2006; 166:781.

2. Klein L, O'Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005; 111:2454.

3. Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007; 28:980.

4. Sato N, Gheorghiade M, Kajimoto K, et al. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol 2013; 111:1019.