Einsatz von Diuretika bei der akut dekompensierten Herzinsuffizienz

Patients with acute heart failure usually present with dyspnea and edema secondary to elevated intracardiac filling pressure resulting from volume overload. Despite significant progress in understanding heart failure, the treatment strategy for acute heart failure did not change in the same way. Diuretics, especially loop diuretics, are the most common drugs used in this setting. Intravenous diuretics act acutely by exerting a modest vasodilatory response and chronically by reducing circulating blood volume. Despite a very common use of diuretics in patients hospitalized with acute heart failure, nearly half of these patients are discharged from the hospital without weight loss. This could be due to inadequate diuresis, overdiuresis with subsequent volume replacement and diuretic resistance. Aggressive diuresis carries a significant risk of electrolyte and volume depletion with subsequent arrhythmias, hypotension, and worsening renal function. Actually, little data from randomized clinical trials are available to guide therapeutic treatment with diuretics. Thus, the choice and dosing of diuretic therapy must be individualized based on general knowledge of potency and pharmacokinetic and pharmacodynamic considerations.