Heart failure treatment aims

Modern diuretics (natriuretics, saluretics), as used in the treatment of hypertension and heart failure, are administered with the aim to enhance the renal excretion of sodium ions and water. Older diuretics, such as the osmotic diuretic agents, are of little interest in the treatment of the aforementioned cardiovascular disorders, but may be used to lower intracranial pressure associated with brain edema. 

What are the overall aims of drug treatment in acute heart failure ... 

Diuretic therapy should be initiated for the acute heart failure. An agent such as furosemide would be appropriate. The aim of the furosemide treatment is to relieve symptoms such as shortness of breath and to make the patient more comfortable. A dose of furosemide 40 mg twice daily (8am and 2pm) would be appropriate as initial therapy. 

The Austrian pharmacologist Heribert Konzett (1912-2004) had discovered in 1940 isoprenaUne, which should become the prototype of p-selective sympathomimetics. Due to its bronchodilatory properties, but without causing hyper-tention, it was considered the drug of choice to treat asthmatic attacks. With almost equally strong effect on pj- and p2-receptors, it was of concern, that isoprenaline acts as a very potent cardiac stimulant. Further structural optimisation then led to more selective pj-sympathomimetics, like dobutamine, for the treatment of heart failure and cardiogenic shock, while selective p2-sympathomimetics were aimed at safer therapies of bronchial asthma. 

---