Document Detail

Central hemodynamic effects of diuretic therapy in chronic heart failure.
MedLine Citation:
PMID:  8435376     Owner:  NLM     Status:  MEDLINE    
In chronic heart failure diuretic drugs improve central hemodynamic variables and cardiac pumping secondary to altered plasma and extracellular volumes; humoral markers of these changes include increased plasma renin and aldosterone levels. The latter increases are maximal over the first week but decline with chronic therapy. The plasma alpha-ANP levels show a reciprocal effect; these data are compatible with a rapid contraction of the plasma volume which is sustained during chronic therapy. The acute hemodynamic actions of diuretic agents reflect both immediate and direct vascular actions and also effects secondary to diuresis (volume redistribution). At rest substantial reductions in pulmonary "wedge" pressure (-29%), with a consequent fall in cardiac output (-10%), are described. Total systemic vascular resistance initially increases but "reverse autoregulation" over subsequent weeks returns this elevation gradually towards control values. Tolerance to these initial hemodynamic effects does not occur with maintained therapy; moreover, echocardiographic markers of contractility and exercise capacity may increase. The early venodilator effects of diuretic drugs can be attributed to prostaglandin release and the initial pressor actions to activation of the renin angiotensin system; these vascular actions may have limited relevance to long-term beneficial effects on hemodynamics. Direct pulmonary vasodilation and improved pulmonary compliance remain an interesting finding. Although most patients are both symptomatically and hemodynamically improved at rest, the actions during exercise are more varied. Some individuals with severely impaired left ventricular function show little hemodynamic improvement, whereas those with milder dysfunction usually benefit; in the main this is probably related to the latter being on a steeper cardiac function curve.(ABSTRACT TRUNCATED AT 250 WORDS)
B Silke
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy     Volume:  7 Suppl 1     ISSN:  0920-3206     ISO Abbreviation:  Cardiovasc Drugs Ther     Publication Date:  1993 Jan 
Date Detail:
Created Date:  1993-03-24     Completed Date:  1993-03-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8712220     Medline TA:  Cardiovasc Drugs Ther     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  45-53     Citation Subset:  IM    
Department of Therapeutics and Pharmacology, Queen's University of Belfast, Northern Ireland.
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MeSH Terms
Bumetanide / pharmacology,  therapeutic use
Cardiac Output / drug effects
Diuresis / drug effects
Diuretics / pharmacology,  therapeutic use*
Furosemide / pharmacology,  therapeutic use
Heart Failure / drug therapy*
Hemodynamics / drug effects*
Muzolimine / pharmacology,  therapeutic use
Plasma Volume / drug effects
Sulfonamides / pharmacology,  therapeutic use
Reg. No./Substance:
0/Diuretics; 0/Sulfonamides; 28395-03-1/Bumetanide; 54-31-9/Furosemide; 55294-15-0/Muzolimine; 55837-27-9/piretanide; 56211-40-6/torsemide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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