Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
Dr. Keld Per Kjeldsen
In heart failure loop diuretics are used to relieve symptoms of congestion. Care should be taken to avoid serious side effects such as dehydration and electrolyte disturbances. Since the effect on mortality is unclear, loop diuretics should probably be reduced to the minimum when there are no longer symptoms of congestion.The problem, however, is how to determine optimum dose. In addition to clinical judgment, the hope is that new imaging modalities and biomarkers may become helpful.In hypertension, thiazides and thiazide-like diuretics are used for monotherapy in light hypertension, and in combination in severe hypertension. Also here, care should be taken to avoid serious side effects such as hypokalemia. In monotherapy, blood pressure is reduced by around 10 mmHg.However, a subsequent decrease in plasma-potassium may increase blood pressure of the same order of magnitude. Thus, in monotherapy it may be considered to shift to other antihypertensives, or in combination therapy it may be considered to discontinue diuretics.Avoiding hypokalemia is one of the major challenges when using diuretics. Here, increased dietary potassium intake, reduced diuretic dose, discontinuation of diuretics, potassium supplementation and aldosterone-antagonists should be considered.Moreover in the RALES and EPHESUS trials these drugs have been shown to significantly reduce mortality in severe heart failure. Also here care should be taken to avoid serious side effects such as hyperkalemia. This is especially the case in renal failure where dosage should be reduced or the drug discontinued. In all patients on these drugs, kidney function and plasma-potassium should be measured regularly. However, it should be kept in mind that moderate hypokalemia generally seems more dangerous - causing arrhythmia and sudden cardiac death - than moderate hyperkalemia. Indications are that potassium-binding resins may become helpful in the treatment with aldosterone antagonists.
Time for reappraisal of diuretics?
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