Sympathetically Mediated Changes in Capacitance Redistribution of the Venous Reservoir as a Cause of Decompensation

Mechanisms that have been proposed previously as leading to ADHF continue to be important in the differential diagnosis of ADHF. In this article, we have described a mechanism that explains the phenomenon of congestion without weight gain: the presence of a compromised venous reservoir unable to buffer shifts of fluid leading to increases in effective circulatory volume and to decompensated heart failure. Additional studies are needed to understand the fundamental pathophysiology of this phenomenon and to determine whether its occurrence depends on increased stimulation of α and/or β receptors. Understanding how abnormalities in baroreflexes or changes caused by ineffective loop gain between veins, arteries, and baroreflexes result in higher filling pressures also will help to clarify the deleterious consequences to the venous reservoir and to the patient. © 2011 American Heart Association, Inc.