Figure 1. Effects of sodium restriction in heart failure.

The figure illustrates the pathophysiology of sodium and fluid handling by the failing heart which results in fluid retention and worsening heart failure (HF) symptoms. As sodium restriction has not been proven to be beneficial nor harmful in randomized clinical trials, we show the potential mechanisms for benefits, which may result in lowered fluid retention and improved HF symptoms as well as the possible mechanisms of harm which paradoxically include increased fluid retention and worsening HF symptoms through compensatory mechanisms adapted from discussion in Khan et al¹¹. RAAS: renin-angiotensin-aldosterone system.