[Use of diuretics in acute decompensated heart failure].
Patients with acute heart failure usually present with dyspnoe and edema secondary to elevated intracardiac filling pressure resulting from volume overload. Despite significant progress in understanding heart failure, the treatment strategy for acute heart failure did not change in the same way. Diuretics, especially loop diuretics, are the most common therapy used in this setting. Intravenous diuretics act acutely by exerting a modest vasodilatory response and chronically by reducing circulating blood volume. Despite near universal use of diuretics in patients hospitalized with acute heart failure, nearly half of these patients are discharged from hospital without weight loss. This could be due to inadequate diuresis, overdiuresis with subsequent volume replacement and diuretic resistance. Aggressive diuresis carries a significant risk of electrolyte and volume depletion with subsequent arrythmias, hypotension, and worsening renal function. Actually there were scant data available from randomized clinical trials to guide therapeutic choice with diuretics. Thus, the choice and dosing of diuretic therapy must be individualized based on general knowledge of potency and pharmacokinetic and pharmacodynamic considerations.
Kardiologie, Pulmologie, Zentrum für Innere Medizin I, Internistische Intensivmedizin, Universitätsklinikum Rostock AöR, Rostock, Germany.
I
I
Akin
H
H
Ince
M
M
Rauchhaus
S
S
Kische
T C
TC
Rehders
R R
RR
Wenzel
C A
CA
Nienaber
T
T
Chatterjee
D000208:Acute Disease; D000465:Algorithms; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D004232:Diuretics