title: Should furosemide be avoided in acute right ventricular myocardial infarction?
abstract: BACKGROUND
  Diuretics are conventionally prohibited in acute right ventricular myocardial infarction.
  
  
  OBJECTIVE
  To assess the benefit of diuretics compared to fluid expansion in patients with inferior myocardial infarction extended to the right ventricule.
  
  
  METHODS
  Of 295 patients admitted for inferior or posterior acute myocardial infarction between November 2008 and November 2010, 77 had a right ventricular extension. Among these 77 patients, 19 presented with oligoanuria (<0.5 mL/kg per hour) and no criteria for cardiogenic shock. Overall, 11 patients were treated by low dose of furosemide (40 to 80 mg) and eight received fluid expansion using isotonic saline solution.
  
  
  RESULTS
  Baseline right ventricular dilatation and dysfunction, systolic blood pressure and heart rate were similar between the groups. Twenty-four hours after treatment, urine output was similar between the two groups but only the patients in the diuretic group improved their blood pressure (103 ± 16 mmHg versus 127 ± 20 mmHg, P < 0.001), heart rate (71 ± 15 bpm versus 76 ± 13 bpm, P = 0.03), creatinin level and alanine aminotrasferase plasmatic level. Hospitalization duration and the need of inotropic support were similar in the two groups.
  
  
  CONCLUSIONS
  Diuretics and fluid expansion provide similar efficiency for triggering diuresis in patients with right ventricular infarction and oligoanuria but only diuretics seem to be associated with improvement in hemodynamic status and venous congestion.
authors.affiliation: Inserm U955, Team 3, Department of Cardiovascular Medicine, Henri Mondor University Hospital, AP-HP, 51, avenue de Lattre-de-Tassigny, 94100 Creteil, France.
authors.forename: J
authors.initials: J
authors.lastname: Ternacle
authors.forename: R
authors.initials: R
authors.lastname: Gallet
authors.forename: T
authors.initials: T
authors.lastname: Cognet
authors.forename: P
authors.initials: P
authors.lastname: Gueret
authors.forename: E
authors.initials: E
authors.lastname: Teiger
authors.forename: J-L
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: P
authors.initials: P
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D006339:Heart Rate / Q000187:drug effects; D006352:Heart Ventricles / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004232:Diuretics; D007552:Isotonic Solutions; D005665:Furosemide; D003404:Creatinine; D000410:Alanine Transaminase