Acute preload effects of furosemide

Acute preload effects (as reflected by the pulmonary capillary wedge pressure [PCWP]) of an intravenous furosemide bolus were studied in 33 patients. In those patients receiving no vasoactive drug and in those receiving predominantly preload reducing agents, there was an initial rise in PCWP up until 15 minutes followed by a diuresis-induced fall in PCWP below baseline levels at 1 h. Patients who were receiving preload and significant afterload reduction showed an immediate drop in PCWP which was sustained. This trend is independent of underlying pathology or dose of furosemide used. It is postulated that furosemide causes an early deleterious release of endogenous vasoconstrictors which may be blocked by combined preload and afterload reduction.