title: Mineralocorticoid receptor antagonists as diuretics: Can congestive heart failure learn from liver failure?
abstract: Despite significant improvements in diagnosis, understanding the pathophysiology and management of the patients with acute decompensated heart failure (ADHF), diuretic resistance, yet to be clearly defined, is a major hurdle. Secondary hyperaldosteronism is a pivotal factor in pathogenesis of sodium retention, refractory congestion in heart failure (HF) as well as diuretic resistance. In patients with decompensated cirrhosis who suffer from ascites, similar pathophysiological complications have been recognized. Administration of natriuretic doses of mineralocorticoid receptor antagonists (MRAs) has been well established in management of cirrhotic patients. However, this strategy in patients with ADHF has not been well studied. This article will discuss the potential use of natriuretic doses of MRAs to overcome the secondary hyperaldosteronism as an alternative diuretic regimen in patients with HF.
authors.affiliation: Division of Cardiology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA, am4052@columbia.edu.
authors.forename: Amirali
authors.initials: A
authors.lastname: Masoumi
authors.forename: Fernando
authors.initials: F
authors.lastname: Ortiz
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
authors.forename: Robert W
authors.initials: RW
authors.lastname: Schrier
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
mesh_terms: D000208:Acute Disease; D004232:Diuretics / Q000627:therapeutic use*; D006177:Gynecomastia / Q000139:chemically induced; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy; D006947:Hyperkalemia / Q000139:chemically induced; D017093:Liver Failure / Q000188:drug therapy; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists