Congestive heart failure edema with, treatment

Treatment of the acute phase of the disease (i.e., fever, malaise, edema of the face, and hepatosplenomegaly) is nifurtimox. The congestive heart failure associated with cardiomyopathy of Chagas disease is treated the same way as cardiomyopathy from other causes. 

Insulin edema is a rare complication, more often seen in the earlier years of insulin therapy (SEDA-11, 364). It is mostly seen when dysregulated patients with progressive weight loss are treated with relatively high amounts of insulin. Reduced sodium excretion (88), sodium reabsorption, and water retention by a possible direct action of insulin on the kidney may be involved (89). The role of aldosterone or of inhibition of the renin-angiotensin-aldosterone system in insulin edema is unclear. Insulin edema is a specific adverse effect, but it can aggravate pulmonary edema, congestive heart failure, and hypertension. Treatment consists of reduction of the insulin dose, after which the edema resolves within 3 days. 

Triamterene can be used in the treatment of congestive heart failure, cirrhosis, and the edema caused by secondary hyperaldosteronism. It is frequently used in combination with other diuretics except spironolactone. Amiloride, but not triamterene, possesses antihypertensive effects that can add to those of the thiazides. 

Diuretics are highly efficient drugs for the treatment of edema associated with congestive heart failure. They are also used to increase the volume of urine excreted by the kidneys [9]. For example, duranide, 81, a dichlorinated benzene disulfonamide, is an oral carbonic anhydrase inhibitor. Duranide reduces intraocular pressure by partially suppressing the secretion of aqueous humor [11]. Diuril, 82, has an antihypertensive activity and is issued to control blood pressure [9]. Edecrin, 83, is an unsaturated ketone derivative of an aryloxyacetic acid. Edecrin is used in the treatment of the edema associated with congestive heart failure, renal disease, and cirrhosis of the liver [11]. Amiloride, 84, is also used as an adjunctive treatment with thiazide diuretics in congestive heart failure hypertension. 

Triamterene may be u.sed alone in the treatment of mild edema associated with congestive heart failure or cirrhosis of the liver with ascites, but it should not be given to patients with impaired renal function." It is not to be used alone in the treatment of hypertension. - Its primary use is in combination with hydrochlorothiazide (or other diuretics that act at site 2 or 3) to prevent the hypokalemia associated with the latter diuretics. 

Amiloride may be used alone in the treatment of mild edema a.ssociated with congestive heart failure, cirrhasis of the liver with ascites, or the nephrotic syndrome or in the treatment... 

Edema and ehronic congestive heart failure may accompany the later stages of emphysema. Mild edema should be controlled with diuretics. Treatment of heart failure is, obviously, much more difficult. The use of digitalis for this purpose should be specifically avoided, however, because digitalis toxicity with arrhythmias can result as a consequence of fluctuating blood gas values (Burrows, 1983). 

Edema and specific drugs for its treatment have long been problems of the physician and of the chemist interested in medicinal products. Digitalis and the many related cardiac glycosides were the first effective agents for the treatment of dropsy associated with congestive heart failure. However, it was soon recognized that the mobilization of the excess tissue fluid associated with this condition was due to a primary action on the heart with improved cardiovascular hemodynamics and only secondarily to an action upon the kidney. 

THERAPEUTIC USES A major use of loop diuretics is in the treatment of acute pulmonary edema. A rapid increase in venous capacitance in conjunction with a brisk natriuresis reduces left ventricular filling pressures and thereby rapidly relieves pulmonary edema. Loop diuretics also are used widely for the treatment of chronic congestive heart failure when diminution of extracellular fiuid volume is desirable to minimize venous and pulmonary congestion see Chapter 33). In this regard, a meta-analysis of randomized clinical trials demonstrates that diuretics cause a significant reduction in mortality and the risk of worsening heart failure, as well as an improvement in exercise capacity. 

Diuretics are used clinically to treat hypertension (see Chapter 32) and to reduce edema associated with cardiac, renal, and hepatic disorders. Three fundamental strategies exist for mobilizing edema fluid correct the underlying disease, restrict Na intake, or administer diuretics. The most desirable course of action would be to correct the primary disease however, this often is impossible. Restriction of Na+ intake is the favored nonpharmacologic approach to the treatment of edema and hypertension and should be attempted however, compliance is a major obstacle. Diuretics therefore remain the cornerstone for the treatment of edema or volume overload, particularly that owing to congestive heart failure, ascites, chronic renal failure, or nephrotic syndrome. 

It is usedfor the control and management of edema associated with congestive heart failure and, alone or in combination with other such agents, in the treatment of hypertension. 

In usual practice, however, it is given in conjunction with hydrochlorothiazide (HCTZ) particularly in the treatment of edema linked with congestive heart failure, cirrhosis of the liver, and the nephrotic syndrome. 

Uses of indapamide inciude the treatment of essentiai hypertension and edema resulting from congestive heart failure. Like metolazone. indapamide is an effective diuretic drug when GFR faiis beiow 40 mL/min. The duration of action is approximately 24 hours, with the normal oral adult dosage starting at 2.5 mg given each morning. The dose may be increased to 5.0 mg/day, but doses beyond this ievei do not appear to provide additional results. Effects on urine content and side effects are similar to effects induced by thiazide diuretics. 

Diuretics are used to increase the volume of urine excreted by the kidneys. They are effective in the treatment of edema associated with congestive heart failure. The thiazide diuretics (e.g., hydrochlorothiazide) have antihypertensive activity and are used to control blood pressure either alone or in combination with other antihypertensive agents. Spironolactone (an aldosterone antagonist) and amiloride are potassium-sparing diuretics. 

It is this reduction in preload that, in some cases, is beneficial to patients experiencing heart failure or hypertension. Unlike a healthy heart, a failing heart is unable to pump all of the blood returned to it. Instead, the blood dams up and overfills the chambers of the heart. This results in congestion and increased pressures in the heart and venous system and the formation of peripheral edema. Because the failing heart is operating on the flat portion of a depressed cardiac function curve (see Figure 14.2), treatment with diuretics will relieve the congestion and edema, but have little effect on stroke volume and cardiac output. 

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