Acute and chronic hemodynamic effects of the basic therapeutic regimen for congestive heart failure. Diuretics, low salt diet and bed rest

The acute and chronic hemodynamic effects of the "basic regimen" for congestive heart failure (CHF), consisting of diuretics (furosemide) low salt diet and bed rest, was studied in 10 patients with CHF (all in NYHA class IV initially). In the acute stage, furosemide 80 mg i.v. effected rapid clinical improvement with reduction in ventricular filling pressures (VFP); however, no increase in cardiac-(CI) or stroke volume index (SVI) was observed. Subsequently, furosemide 80 mg/day, p.o. was administered for a mean of 30 days with the patients hospitalized on a low salt diet. During this period, their clinical condition was stable. The second hemodynamic study revealed that SVI increased (p less than 0.05) with reduction in VFP maintained. Next, low molecular weight dextran was infused to construct the Frank-Starling ventricular function curve (VFC) and this was compared with the VFC at the acute stage (during diuresis). As a whole, CI and SVI at the chronic stage were significantly increased (p less than 0.05) at equal pulmonary wedge pressures (PWP: mean 20 mmHg). Mean arterial pressure and systemic vascular resistance were decreased during the chronic stage. These findings suggest that the "basic CHF regimen" is effective on a chronic basis in improving left ventricular pump function through afterload and preload reduction, in addition to acute symptomatic relief due to a decrease in PWP.