II. Details: Therapeutic Agents for Chronic Heart Failure; 3. Diuretics

Diuretics in congestive heart failure

Diuretics (see Table 1.1 for a physiological classification) remain an important part of the medical therapy for patients with congestive heart failure (CHF). They control fluid retention and rapidly relieve the congestive symptoms of heart failure (HF). The American College of Cardiology/American Heart Association assigned them a class I indication in patients with symptomatic heart failure wh...

Diuretics as pathogenetic treatment for heart failure

Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heart failure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history...

Haemodynamic effects of diuretics in heart failure.

The organic mercurials have been known to have a diuretic effect since the sixteenth century, but their use for treating dropsy first began in 1920 in Vienna, when it was realised that a mercury compound being used to treat syphilis greatly increased urine output. The direct descendant of that compound was mersalyl, which was to remain the drug of choice until 1951, when the carbonic anhydrase ...

Vascular effects of diuretics in heart failure.

Responsiveness to loop diuretics in heart failure.

Loop diuretics are the most commonly used drugs in the management of pulmonary and systemic congestion in patients with acute decompensated heart failure (ADHF), as well as chronic congestive HF. The diuresis results from blockade of the Na+–K+–Cl2 co-transporter in the ascending limb of the loop of Henle. The pharmacodynamics of loop diuretics are illustrated in Figure 1, and are best describe...