 Manifestations of CHF include symptoms of volume overload such as dyspnea, abdominal bloating andor fatigue. The genesis of these symptoms begins with loss of the integrity of arterial circulation due to decreased cardiac output 2. Decreased activation of mechanoreceptors in the carotid sinus, left ventricle, aortic arch and renal afferent arterioles due to lower systemic arterial pressure stimulates the sympathetic nervous system SNS, renal-angiotensin-aldosterone system RAAS and non-osmotic release of arginine vasopressin 3. As a result, sodium reabsorption in the proximal tubule followed by water absorption increases causing accumulation of intravascular volume to compensating for arterial underfilling 4. Consequently, activation of neurohumoral reflexes result in increased cardiac afterload and preload, cardiac remodeling, hyponatremia and pulmonary edema 5. Renal vasoconstriction, sodium and water retention leads to a continuous positive feedback loop of further salt and water accumulation accompanied by further renal vasoconstriction 6. 