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Heart Failure Drugs: Diuretics01:22

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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...
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Heart Failure V: Medical Management01:30

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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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Heart Failure II: Pathophysiology01:29

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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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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...
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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Pathophysiology of Heart Failure01:17

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
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Factors Predicting Diuretic Resistance in Patients With Acute Decompensated Heart Failure.

Rarsari Soerarso1, Dian Yaniarti Hasanah1, Emir Yonas1

  • 1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia.

Journal of Clinical Medicine Research
|April 22, 2026
PubMed
Summary

Diuretic resistance impacts 68% of acute decompensated heart failure patients. Key predictors include diabetes, prior diuretic use, low ejection fraction, and specific lab values, aiding in developing a predictive scoring system.

Keywords:
Cardiorenal syndromeCongestive heart failureHeart decompensationHeart failureSystolic heart failure

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Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Acute decompensated heart failure (ADHF) is a significant cause of mortality and morbidity globally.
  • Diuretic resistance affects 20-30% of ADHF patients, predicting poor outcomes, mortality, and re-admission.
  • Identifying factors and indicators of diuretic resistance is crucial for improving patient management.

Purpose of the Study:

  • To identify factors influencing diuretic resistance in ADHF patients.
  • To investigate clinical characteristics as indicators of diuretic resistance incidence.
  • To develop a clinical scoring system for predicting diuretic resistance.

Main Methods:

  • A retrospective cohort study of 535 ADHF patients from January to December 2019.
  • Diuretic resistance defined as <1400 mL diuresis in 24h after 40 mg IV furosemide.
  • Bivariate and multivariate analyses to develop a predictive scoring system.

Main Results:

  • Diuretic resistance observed in 68% of patients.
  • Independent predictors: diabetes mellitus, prior IV loop diuretic use (>6 days), high oral loop diuretic dose (>80 mg/day), LVEF ≤49%, BUN ≥21 mg/dL, and serum chloride <98 mmol/L.
  • A clinical scoring system was developed based on these predictors.

Conclusions:

  • Diabetes, prior diuretic use, dosage, LVEF, BUN, and serum chloride are significant predictors of diuretic resistance in ADHF.
  • These factors can be synthesized into a clinical scoring system to predict diuretic resistance.
  • The scoring system can aid clinicians in managing ADHF patients with potential diuretic resistance.