Figure 2.

Gut Hypothesis of Heart Failure

Progressive effects of hypoperfusion on the mucosal barrier. (A) Normal mucosa is affected by (B) low cardiac output, which results in ischemia. (C) Chronic ischemia and reperfusion−injury cause a release in reactive oxygen species, erosion, and distortion of the mucosal barrier. (D) Acute decompensation of chronic heart failure increases the risk of microperforations that facilitates organism translocation into the ascitic fluid. With a weakened immune response and low interleukin-17, the host becomes predisposed to multiple infections, including fungi. Antibiotics change intestinal flora, which facilitates the growth of fungal species, which then may translocate into the ascitic fluid. CO₂ = carbon dioxide; O₂ = oxygen.