role of diuretics in the management of congestive heart failure

1. ROLE OF DIURETICS
IN THE MANAGEMENT
OF CONGESTIVE
HEART FAILURE

2. DIURETICS
 A diuretic is any drug that elevates the rate of
urination and thus provides a means of forced
diuresis.
 These are the only drugs which produce rapid
symptomatic effects in c.h.f conditions.
 They are used in combination with an ACE
inhibitor and a β-blocker in order to optimize
their effectiveness.
 They relieve the symptoms but donot cure
the underlying cause.

3. Why are the diuretics used?
Diuretics are used in the treatment of c.h.f
because they:-
1) Decrease preload and improve ventricular
efficiency by reducing circulating volume.
2) Removes peripheral edema and pulmonary
congestion.

4. Reduced cardiac
output
Heart Failure
Sympathetic nervous system
activation
Vasoconstriction
Cardiac Remodeling
Renin-angiotensin
system
Sodium and
water retention
Elevated cardiac
filling pressure
Diuretics

5. Diuretics used in the
treatment of C.H.F
1) Loop diuretics
2) Thiazide diuretics
3) K sparing diuretics

6. Loop diuretics
 These drugs have the highest efficacy in
mobilizing water & Na+ from the body.
 Furosemide, bumetanide, torasemide and
ethacrynic acid are the four loop diuretics.
 Furosemide is the most commonly used loop
diuretic.

7. Mechanism of action
 They inhibit the
cotransport of Na+/ K+/Cl-
in the luminal membrane
of ascending loop of
henle.
 They are considered as
the most efficacious as
the ascending loop
accounts for the
reabsorption of 25 to
30% of the filtered NaCl

8. Therapeutic Use in c.h.f
 It is the drug of choice for rapid mobilization
of edema fluid in moderate to severe cases of
c.h.f.

9. Thiazide diuretics
 These are medium efficacy diuretics.
 They are also called ceiling diuretics because
increasing the dose above normal does not
promote a further diuretic response.
 Ex:- Hydrochlorothiazide, benzthiazide,
hydroflumethiazide, clopamide .

10. Mechanism of action
 They inhibit the
Na+ /Cl- cotransport
present on the luminal
membrane of distal
convoluted tubule.
Therapeutic use in c.h.f
 They are used in the treatment of mild
to moderate heart failure.

11. Adverse effects of loop &
thiazide diuretics
1) Hypokalaemia
2) Dilutional hyponatraemia
3) Git and cns symptoms
4) Ototoxicity
5) Hyperuricaemia
6) Hypomagnesia
7) Hyercalcaemia in thiazide whereas
hyocalcaemia in loop diuretics

12. Spironolactone (Aldosterone inhibitor)
recent evidence suggests that it may improve
survival in CHF patients due to the effect on
renin-angiotensin-aldosterone system with
subsequent effect on myocardial remodeling
and fibrosis

13. K+ sparing diuretics

14. General effects
They act
as venodilators and, when giving
intravenously,
reduce right atrial and pulmonary capillary
wedge
pressure within minutes