- What Are They?
- Used For
- Side Effects
What is congestive heart failure?
Congestive heart failure is a condition in which the heart is unable to efficiently pump blood to meet the body’s oxygen and nutrient needs. This impairs normal blood circulation and leads to excess fluid in the blood. The excess fluid leaks out of the blood vessels and accumulates in the lungs and other tissues.
Congestive heart failure is a progressive disease and has to be managed with medication and lifestyle habits. The primary symptoms of congestive heart failure include:
What are 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.
Why are diuretics used in heart failure?
Diuretics are an integral part of heart failure treatment, along with other medications to treat the underlying cause of heart failure. 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 other tissues drains back into the circulation, providing symptom relief.
Do diuretics improve mortality in heart failure?
Studies show that diuretics improve blood flow and reduce the symptoms of heart failure, but do not clearly demonstrate an improvement in mortality in heart failure or arrest in disease progression with diuretic use. The effectiveness of diuretics may be limited by some of their adverse effects.
How do diuretics work?
The kidney is made up of microscopic functional units known as nephrons. 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. Diuretics inhibit the nephron’s proteins, inducing the kidneys to flush minerals along with excess water.
Can diuretics cause irregular heartbeat?
Certain classes of diuretics flush out potassium in the urine, which can lead to low potassium levels in the blood. Potassium-sparing diuretics, on the contrary, may increase potassium levels. An imbalance in the blood potassium level can cause irregular heartbeat, and must be monitored.
Which diuretics are used in heart failure?
Diuretics may be taken as pills for early stages of heart failure, but may be administered intravenously for hospitalized patients. People who take diuretics on a long-term basis must regularly check their kidney function and electrolyte levels because of the extra urine output and loss of minerals.
People may develop resistance to diuretics gradually, in which case a combination of diuretics may be effective.
Loop diuretics inhibit a protein found in a part of the nephron known as the loop of Henle. Currently available loop diuretics include:
Ethacrynic acid is rarely used except by those with sulfa allergies, as the other three are sulfonamide diuretics.
Thiazide and thiazide-like diuretics
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:
- Chlorothiazide (Diuril)
- Hydrochlorothiazide (Hydrodiuril)
- 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. Following are the aldosterone antagonists currently available in the US:
- Spironolactone (Aldactone)
- Eplerenone (Inspra)
- Amiloride (Midamor)
- Triamterene (Dyrenium)
- Carbonic anhydrase inhibitor
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:
- 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 of a machine. A catheter placed in the vein carries the blood to a filtration machine and brings it back into circulation after the removal of excess fluid.
What are the risks and side effects of diuretic use in heart failure?
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
- Hyponatremia: Low sodium
- Hypercalcemia: High calcium
- Hyperuricemia: High level of uric acid
- Hypochloremic metabolic alkalosis: Increase in pH level because of chloride loss
- Hyperkalemia: High potassium from potassium sparing diuretics
Side effects include:
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Congestive heart failure is a condition in which the heart is unable to efficiently pump blood to meet the body’s oxygen and nutrient needs. This leads to excess fluid in the blood that leaks from blood vessels and accumulates in the lungs and other tissues. Diuretics treat this symptom by causing the kidneys to filter out more fluid as urine.
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Related Disease Conditions
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
What Are the 4 Stages of Congestive Heart Failure?
The New York Heart Association developed the four stages of congestive heart failure depending on the functional capabilities of the heart which includes Class I, Class II, Class III, and Class IV.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
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What Causes Congestive Heart Failure?
Congestive heart failure is a chronic disease that progresses with time if left untreated. Heart failure can occur due to diseases of the heart, the blood vessels supplying oxygen and nutrients to the heart, or sometimes from factors outside the heart (extracardiac causes). With proper management, people who have congestive heart failure can lead nearly normal lives, depending on the severity of the condition.
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