Choice of a powerful diuretic

Most patients with heart failure and oedema should be treated with thiazide diuretics, which are effective, cheap, safe and easy to use. However, in severe congestive cardiac failure and renal failure haemodynamic and perhaps hormonal disturbances cause salt and water retention which resists thiazide diuretics. Patients with acute pulmonary oedema need a rapid intense diuresis which a thiazide diuretic cannot provide. In these circumstances a drug is needed which can cause the excretion of a substantial fraction of filtered sodium.

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New diuretics - bumetanide and metolazone

Drug and Therapeutics Bulletin ◽

10.1136/dtb.12.13.49 ◽

1974 ◽

Vol 12 (13) ◽

pp. 49-51

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Liver Disease ◽

Orthostatic Hypotension ◽

Pulmonary Oedema ◽

The Elderly ◽

Electrolyte Imbalance ◽

Acute Pulmonary Oedema ◽

Moderate Heart Failure

The temptation to use a powerful and rapidly acting diuretic in every patient who needs one, often results in the use of frusemide as an all-purpose diuretic. Unfortunately there is no such thing as an all-purpose diuretic. Although frusemide is very valuable in acute pulmonary oedema, thiazide-resistant oedema, ascites due to liver disease and renal failure, the intense diuresis it can produce may cause orthostatic hypotension in the elderly, and acute electrolyte imbalance which can be serious, especially in digitalised patients. For many patients with mild or moderate heart failure a less powerful diuretic, such as a thiazide, will be safer, and just as effective. Two new diuretics have recently been promoted for many of these situations, but it is by no means clear in which of them they offer a tangible advantage.

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Interleukin-6 Could Be a Potential Prognostic Factor in Ambulatory Elderly Patients with Stable Heart Failure: Results from a Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10030504 ◽

2021 ◽

Vol 10 (3) ◽

pp. 504

Author(s):

Marina Povar-Echeverría ◽

Pablo Esteban Auquilla-Clavijo ◽

Emmanuel Andrès ◽

Francisco Javier Martin-Sánchez ◽

María Victoria Laguna-Calle ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Renal Failure ◽

Interleukin 6 ◽

Kaplan Meier ◽

Patients With Heart Failure ◽

Potential Prognostic Factor ◽

Fundamental Phenomenon ◽

Group 2

Introduction: Inflammation is a fundamental phenomenon in heart failure, but the prognostic or therapeutic role of markers such as interleukin-6 (IL-6) has not yet been clarified. The objective of this study is to describe the clinical profile of patients with elevated IL-6 and determine if they have worse clinical outcomes. Methods: A retrospective c.ohort observational study including 78 patients with heart failure followed up at the Heart Failure Outpatient Clinic of the Internal Medicine Department. IL-6 was determined in all patients, who were then assigned into two groups according to IL-6 level (normal or high). Clinical and prognostic data were collected to determine the differences in both groups. Results: The average age was 79 years, 60% female. A total of 53.8% of the patients had elevated IL-6 (group 2). Patients with elevated IL-6 presented more frequently with anemia mellitus (64.3% vs. 41.7%; p = 0.046), atrial fibrillation (83.3% vs. 61.9% p = 0.036), dyslipidemia (76.2% vs. 58.2%; p = 0.03), higher creatinine levels (1.35 mg/dL vs. 1.08 mg/dL; p = 0.024), lower glomerular filtration rate (43.6 mL/min/m2 vs. 59.9 mL/min/m2; p = 0.007), and anemia 25% vs. 52.4% p = 0.014. The factors independently associated with the increase in IL-6 were anemia 3.513 (1.163–10.607) and renal failure 0.963 (0.936–0.991), p < 0.05. Mortality was higher in the group with elevated IL-6 levels (16% vs. 2%; p = 0.044) with a log-rank p = 0.027 in the Kaplan–Meier curve. Conclusion: Patients with heart failure and elevated IL-6 most often have atrial fibrillation, diabetes mellitus, dyslipidemia, anemia, and renal failure. In addition, mortality was higher and a tendency of higher hospital admission was observed in stable HF patients with elevated IL-6.

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Creatine Phosphokinase Activity in Myocardial Infarction, Heart Failure, and Following Various Diagnostic and Therapeutic Procedures

Clinical Chemistry ◽

10.1093/clinchem/14.12.1185 ◽

1968 ◽

Vol 14 (12) ◽

pp. 1185-1196 ◽

Cited By ~ 16

Author(s):

Leonard V Crowley

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Electroconvulsive Therapy ◽

Cardiac Failure ◽

Creatine Phosphokinase ◽

Coronary Arteriography ◽

Surgical Operation ◽

Patients With Heart Failure ◽

Therapeutic Procedures ◽

Infarction Heart

Abstract The creatine phosphokinase(CPK) test based on the method of Okinaka et al. (1) was compared with the glutamic oxalacetic transaminase (GOT) test of Reitman and Frankel (2) in patients with myocardial infarction, cardiac failure, and following various diagnostic and therapeutic procedures. The CPK method used was somewhat less discriminatory than the GOT method in detecting myocardial infarction. The CPK test possessed greater specificity, since it was not elevated in congestive cardiac failure, while the GOT test was elevated in 25% of the patients with heart failure. Therefore, the CPK test offered a real advantage when evaluating suspected infarction in the presence of cardiac failure. CPK activity may be elevated when the GOT test is normal, indicating the advantage of performing more than one enzyme procedure in suspected myocardial infarction. Both GOT and CPK were elevated in many patients following surgical operation and cardiac catheterization. No CPK elevations were encountered after electroconvulsive therapy, and CPK was only occasionally elevated following coronary arteriography.

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Diazepam Metabolism in Healthy Subjects and Patients with Heart Failure, Renal Failure and Hepatic Cirrhosis

Neuro-Psychopharmacology ◽

10.1016/b978-0-08-023089-4.50052-1 ◽

1979 ◽

pp. 459-466

Author(s):

L. HILLESTAD ◽

T. HANSEN

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Healthy Subjects ◽

Hepatic Cirrhosis ◽

Patients With Heart Failure

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Renal failure in patients with heart failure - analysis based on ESC-HF Pilot survey

European Heart Journal ◽

10.1093/eurheartj/eht307.p645 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P645-P645 ◽

Cited By ~ 1

Author(s):

M. M. Stasiak ◽

P. Rozentryt ◽

E. Jankowska ◽

A. Retwinski ◽

E. Straburzynska-Migaj ◽

...

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Failure Analysis ◽

Pilot Survey ◽

Patients With Heart Failure

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Atrial natriuretic peptides in man

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y87-266 ◽

1987 ◽

Vol 65 (8) ◽

pp. 1697-1700 ◽

Cited By ~ 2

Author(s):

M. Gary Nicholls ◽

Hamid Ikram ◽

Ian G. Crozier ◽

Eric A. Espiner ◽

Tim G. Yandle

Keyword(s):

Heart Failure ◽

Renal Failure ◽

Physiological Role ◽

High Sodium ◽

Patients With Heart Failure ◽

Normal Man ◽

Urine Electrolytes ◽

Pulmonary Arterial ◽

Atrial Natriuretic

Research on the physiological role of atrial peptides in man is limited, and the potential for these peptides, or more stable analogues, in therapeutics is uncertain. It is clear, however, that plasma levels of immunoreactive atrial natriuretic peptide (IR-ANP) are increased in volunteers taking a high sodium diet, and are elevated in patients with heart failure, chronic renal failure, and primary aldosteronism. There is suggestive evidence that IR-ANP levels are increased also in essential hypertension, although overlap with normotensives is considerable. Injection or infusion of artrial peptides into man results in a diuresis, an increased output of urine electrolytes, a fall in blood pressure and a rise in heart rate, suppression of aldosterone and sometimes of renin also, and stimulation of norepinephrine. In essential hypertensives, urinary effects may be greater than in normotensives. Heart failure patients show a rise in cardiac output and falls in both systemic and pulmonary arterial pressure. Over the next few years and especially if specific antagonists can be developed, the physiologic and pathophysiologic roles of atrial peptides in normal man and in clinical disorders should be clarified. It is possible that stable analogues of atrial peptides will find a place in the treatment of cardiac failure, renal failure, and perhaps hypertension.

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