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Related Concept Videos

Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
472
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Antihypertensive Drugs: Potassium-Sparing Diuretics01:28

Antihypertensive Drugs: Potassium-Sparing Diuretics

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Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
730
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

497
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
497
Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

53
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
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Antihypertensive Drugs: Action of Diuretics01:16

Antihypertensive Drugs: Action of Diuretics

859
Diuretics are antihypertensive drugs used to treat hypertension resulting from sodium and water retention. Sodium, vital for fluid balance and nerve or muscle function, is regulated by the kidneys through millions of nephrons. Blood enters nephrons via afferent arterioles, which branch into capillaries called glomeruli. These filter blood plasma, allowing water and solutes, like sodium ions, to pass through capillary walls into Bowman's capsule. The filtrate then flows through various...
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Real-time Pressure-volume Analysis of Acute Myocardial Infarction in Mice
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Loop Diuretic Use is Associated With Adverse Clinical Outcomes in Acute Myocardial Infarction Patients With Low

Tsutomu Kawai1, Daisaku Nakatani2, Tetsuya Watanabe1

  • 1Division of Cardiology, Osaka General Medical Center, Osaka, Japan.

Current Problems in Cardiology
|July 23, 2022
PubMed
Summary

Loop diuretic use after acute myocardial infarction (AMI) increases poor prognosis risk in patients with low plasma volume status. Careful observation is needed for these AMI patients without plasma volume expansion.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Acute myocardial infarction (AMI) management involves addressing fluid balance.
  • Loop diuretics are commonly prescribed, but their impact on prognosis varies.
  • Plasma volume status is a critical factor in cardiovascular outcomes.

Purpose of the Study:

  • To investigate the prognostic impact of loop diuretics in AMI patients.
  • To assess if plasma volume status modifies the effect of loop diuretics.
  • To determine optimal diuretic use in post-AMI care.

Main Methods:

  • Study included 3,364 AMI survivors from the Osaka Acute Coronary Insufficiency Study (OACIS) database.
  • Plasma volume status assessed by estimated plasma volume status (ePVS) at discharge.
  • Composite endpoint of all-cause death and heart failure rehospitalization over 5 years.

Main Results:

  • Loop diuretic use was linked to increased risk in patients with low ePVS (HR 2.572).
  • No significant increased risk was observed in patients with high ePVS (HR 1.028).
  • Findings remained consistent in propensity-score matched cohorts.

Conclusions:

  • Loop diuretic prescription at discharge is associated with poor prognosis in AMI patients without plasma volume expansion.
  • Careful monitoring is essential when prescribing loop diuretics for AMI patients with low plasma volume.
  • Plasma volume status is a key determinant of loop diuretic efficacy and safety post-AMI.