Thiazide diuretics are most commonly used to treat hypertension, although they can be adjuncts in the management of heart failure. They inhibit the Na-Cl symporter in the distal convoluted tubule, leading to decreased sodium and water reabsorption.
What is the relationship between diuretics and heart failure?
This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon …
Can people in heart failure safely reduce diuretics?
Jul 31, 2020 · Diuretic use for heart failure carries some risks because the loss of minerals can cause electrolyte imbalance and lead to conditions such as: Hypokalemia : Low potassium Hypomagnesemia : Low magnesium
When can I stop taking furosemide?
Jul 29, 2015 · However, loop diuretics (e.g., furosemide, torsemide, or bumetanide) are the principal drugs used in the treatment of heart failure [ 22 ]. Severe heart failure causes decrease in the rate of absorption of loop diuretics. Hence, peak response arises 4 hours or more after the dose has been administered [ 23 ].
What are diuretics and how do they work?
Apr 04, 2016 · The use of diuretics in the management of chronic heart failure may be limited by the increase in cardiovascular risk secondary to their adverse effects including electrolyte depletion (potassium and magnesium).
What is the effect of diuretics to be used in heart failure treatment?
Diuretics. Diuretics (water pills) make you pass more urine and help relieve ankle swelling and breathlessness caused by heart failure. There are many different types of diuretic, but the most widely used for heart failure are furosemide (also called frusemide) and bumetanide.
What are the side effects of diuretics?
Side effects include increased urination and sodium loss. Diuretics can also affect blood potassium levels....Other possible side effects of diuretics include:Dizziness.Headaches.Dehydration.Muscle cramps.Joint disorders (gout)Impotence.
How do diuretics affect heart?
Acute elevation of left ventricular preload (end-diastolic pressure) directly leads to elevated left atrial pressures and pulmonary edema. Diuretics reduce intravascular volume, leading to a decrease in central venous pressure, right and left heart filling pressures, and pulmonary vascular pressures.Aug 24, 2021
Do diuretics cause heart failure?
Potential adverse effects of diuretic therapy The use of diuretics in the management of chronic heart failure may be limited by the increase in cardiovascular risk secondary to their adverse effects including electrolyte depletion (potassium and magnesium).
What is the most common adverse reaction of diuretics?
Two of the commonest side effects are mild hypovolaemia, when any diuretic is used, and mild hypokalaemia when the non-potassium-sparing diuretics, such as thiazides and frusemide are used.
What does diuretic effect mean?
A type of drug that causes the kidneys to make more urine. Diuretics help the body get rid of extra fluid and salt. They are used to treat high blood pressure, edema (extra fluid in the tissues), and other conditions.
Do diuretics treat congestive heart failure?
The clinical and functional effects of diuretics. Effective diuretic therapy provides impressive symptomatic relief in patients with CHF. Haemodynamically, forced diuresis results in a decrease in pulmonary circulation wedge pressure, and stroke volume and cardiac output decrease initially.Apr 24, 2002
What is the main therapeutic purpose for diuretic therapy in HFrEF patients?
Diuretic therapy for heart failure Diuretics are used to control symptoms of fluid retention and maintain euvolaemia. They should never be used as sole therapy for HFrEF as they do not improve survival in HF.
What is the best diuretic for heart failure?
Loop diuretics remain the diuretic of choice for treating patients with heart failure. Furosemide, torsemide and bumetanide are the agents widely available for clinical use, with furosemide the predominant agent of the three.Sep 12, 2017
Why does heart failure cause fluid retention?
Congestive heart failure. If you have congestive heart failure, one or both of your heart's lower chambers lose their ability to pump blood effectively. As a result, blood can back up in your legs, ankles and feet, causing edema.Dec 1, 2020
Which diuretic is contraindicated in heart failure?
Combination of aminoglycosides and loop diuretics should be avoided because of the risk of ototoxicity. A low sodium diet (less than 2.4 g sodium) and fluid restriction (less than 1.5 l fluid) can reduce the need to use higher doses in advanced heart failure.
What causes the need for diuretics?
They are commonly prescribed for conditions like heart failure, chronic kidney disease, and high blood pressure. Diuretics signal the kidneys to excrete more water and sodium. That reduces swelling and allows blood to flow more freely throughout the body.
What is the purpose of diuretics?
Diuretics, also known as water pills, are medications that promote urination and reduce fluid retention in the body. Diuretics inhibit the kidney from reabsorbing sodium, which normally happens during blood filtration. The release of sodium also leads to the elimination of excess fluid by way of increased urine output.
How do diuretics help the kidneys?
Diuretics help the kidneys flush out the excess fluid and maintain normal blood volume. The elimination of excess fluid reduces pressure in the veins and the overload of venous blood into the heart. As a result, the heart requires less effort to pump out blood, and the blood pressure in the arteries drops. The fluid accumulated in the lungs and ...
What is the name of the enzyme that balances the pH of the blood?
A carbonic anhydrase is an enzyme that balances the blood pH levels. Carbonic anhydrase inhibitors block the enzyme, promoting the excretion of sodium, potassium, bicarbonate and water. The carbonic anhydrase inhibitor used for heart failure is: Acetazolamide ( Diamox)
What are non-diuretic alternatives?
Non-diuretic alternatives. Vasopressin antagonists: Vasopressin antagonists are a new class of drugs being studied for use in heart failure. This class of drugs works by blocking vasopressin, which is an antidiuretic hormone produced by the pituitary gland. Ultrafiltration: Ultrafiltration is the removal of excess fluid in the blood with the use ...
What is thiazide used for?
Thiazide diuretics are commonly used to treat high blood pressure ( hypertension ), but also to manage heart failure. Thiazide diuretics inhibit a different protein than the loop diuretics do, which also helps in mineral reabsorption. Thiazide diuretics include:
What are the functions of the kidney?
The nephrons produce certain proteins which help filter the wastes from the blood, and reabsorb minerals such as sodium, potassium and chloride for circulation in the blood.
What is the name of the drug that blocks sodium absorption?
Metolazone (Zytonix) – thiazide-like. Potassium-sparing diuretics (aldosterone antagonists) Aldosterone is a hormone produced by the adrenal gland, which activates sodium absorption and potassium removal. Aldosterone antagonists block the release of aldosterone, preventing sodium absorption as well as potassium depletion.
What is loop diuretic?
Loop diuretics. Loop diuretics form the backbone of diuretic therapy in acute heart failure, being used in over 90% of patients . 3 Loop diuretics are heavily protein-bound (> 90%) and need to be secreted into the proximal convoluted tubule through several organic anion transporters.
What is the most useful physical finding for determining a patient's volume status?
As such, the jugular venous pulse is the most useful physical finding for determining a patient's volume status. Not only does an elevated jugular venous pulsation (JVP) detect systemic congestion, but there is good sensitivity (70%) and specificity (79%) between high JVP and elevated left-sided filling pressure.
What Is Heart Failure?
Heart failure is the inability of the heart muscle to move a sufficient volume of blood to fuel normal activities. Diuretics eliminate pressure on a failing heart by reducing fluid accumulation.
How Is Heart Failure Diagnosed?
The diagnosis of heart failure starts with a physical exam which includes a doctor listening to the heart with a stethoscope.
What Is the Treatment for Heart Failure?
Treatment for heart failure includes lifestyle and diet changes, medications, and sometimes implanted devices. In severe cases, a heart transplant may be needed.
How Do You Prevent Heart Failure?
Heart failure can be prevented and even reversed in some cases by many of the same lifestyle changes used to treat the condition, including:
What is the main goal of diuretics?
The main goal of diuretics is to reduce the amount of fluid in the body. This leads to symptom relief, lower blood pressure and a decreased risk of hospitalization for heart failure. 2
How does diuretic work?
There are different classes of diuretics and each works in a distinct way in the kidneys to remove fluid buildup from the body which reduces pressure on blood vessel walls. 2-3 As the kidneys eliminate the excess water from the blood, the total blood volume that the heart has to pump is reduced, which causes blood pressure to go down and makes it easier for the heart to pump forward. 4
Can diuretics cause low potassium?
Common side effects of diuretics include muscle weakness, fatigue, or low potassium. Most people experience an increased frequency of urination. Medications can take time to work properly and get adjusted. Diuretics tend to work quickly and doses may need to be adjusted frequently. If you find that frequently going to the bathroom interferes with your sleep or certain activities, talk to your doctor about adjusting the medication schedule. 1
Use of Loop Diuretics in Patients with Acute Decompensated Heart Failure
The limited evidence to guide diuretic use in patients with heart failure in general is reflected in contemporary practice guidelines, which give diuretics a class I recommendation, but it is based on level B or level C evidence.
Adjuncts to Diuretic Treatment
Although retention of renal sodium chloride is the major determinant of congestion in heart failure, hyponatremia, indicating water accumulation, is common and portends a poor prognosis. 38 The oral vasopressin-2 receptor antagonist tolvaptan inhibits the action of antidiuretic hormone and increases excretion of free water (aquaresis).
Treatment of Diuretic Resistance
Diuretic resistance is defined as the failure of diuretics to achieve decongestion, which is manifest by a low urine sodium concentration, despite the use of maximal recommended doses. Continuous infusion of diuretic therapy is frequently used in such patients.
Other Approaches and Future Directions
The use of extracorporeal ultrafiltration is a theoretically attractive method with which to remove sodium chloride and water, with less stimulation of the renin–angiotensin–aldosterone system and a lower risk of rehospitalization than the risk associated with the use of diuretics.
Author Affiliations
From the Oregon Clinical and Translational Research Institute, Oregon Health and Science University and the Veterans Affairs Portland Health Care System, Portland (D.H.E.); and Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (G.M.F.).
References (78)
1. Gheorghiade M, Follath F, Ponikowski P, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010 ;12: 423 - 433