Heart failure, referred to as heart failure, is a group of clinical syndromes caused by any abnormalities in the structure or function of the heart that cause ventricular filling and/or impaired ejection ability. The main clinical manifestations are dyspnea, fatigue and fluid retention. Diuretics are the most commonly used drugs for the treatment of heart failure. By increasing the excretion of water and sodium, reducing the patient’s heart volume load, alleviating the symptoms of congestion, and reducing edema, it is the cornerstone of heart failure treatment. Commonly used diuretics include thiazides, loop diuretics, potassium-sparing diuretics, etc. Scientific and rational use can effectively improve the quality of life of patients.
Here is a brief introduction to these types of drugs.
Loop diuretics are suitable for most patients with heart failure, especially for patients with significant fluid retention or impaired renal function, including furosemide, torasemide, and bumetanide. 40mg furosemide, 10mg torsemide and 1mg bumetanide have similar diuretic effects. The most commonly used clinical diuretic is furosemide, and its dose has a linear relationship with its effect; because torsemide and bumetanide have higher oral bioavailability, they have better diuretic effects for some patients.
Thiazides are less effective than loop diuretics and are only suitable for patients with heart failure with mild fluid retention, hypertension and normal renal function. It mainly contains benzflurothiazide, hydrochlorothiazide, and metolazone. In patients with impaired renal function, the effect of thiazide diuretics is weakened and is not recommended, but in patients with refractory edema (the daily dosage of furosemide exceeds 80 mg), thiazide diuretics can be combined with loop diuretics.
The main role of potassium-sparing diuretics is to promote the excretion of sodium ions and water, while potassium ions are not excreted. The commonly used potassium-sparing diuretics in clinic are spironolactone and triamterene. Currently, spironolactone is widely used, and it is mostly used for diuretic treatment of combined hypokalemia. Potassium-sparing diuretics have relatively weak diuretic effects and are generally used together with hydrochlorothiazide, a thiazide diuretic, to maintain the balance of potassium ions in the body. When applying potassium-sparing diuretics, attention should be paid to recheck blood biochemistry and the changes of potassium ions. In addition, patients with hyperkalemia should be disabled and those with renal insufficiency should be used with caution.
In addition, tolvaptan is currently recommended for patients with congestive heart failure, poor efficacy of conventional diuretics, hyponatremia, or a tendency to impair renal function. This medicine can be used in combination with loop diuretics and has a synergistic diuretic effect.
In addition to drug treatment, patients with heart failure should also pay attention to their lives. Studies have shown that about 30% of patients with heart failure will be hospitalized again within 2 to 3 months of discharge, and about 70% of patients will be hospitalized again within 1 year of discharge. So, what should patients with heart failure do in their lives? For details, please refer to the following-
diet: low-salt, low-fat, easy-to-digest diet, small and frequent meals, each meal should not be oversatisfied, eat more fresh fruits and vegetables. Choose foods rich in high-quality protein, such as milk, lean meat, and freshwater fish. For patients with acute heart failure and volume overload, the sodium intake is less than 2 grams per day. Limit foods with high sodium content such as: pickled or smoked products, sausages, canned food, seafood, soda crackers, etc. Pay attention to cooking skills. Use sugar, sugar substitutes, vinegar and other condiments to increase appetite.
Prevent constipation: Develop a good habit of defecation every day, drink a glass of warm water every morning or before breakfast. Massage the abdomen with both hands every day, centering on the navel, massage in a clockwise direction with moderate intensity, no less than 30 laps each time to promote bowel movements.
Work and rest on time: Work and rest regularly, go to bed early and get up early, avoid staying up late, ensure adequate sleep, and increase your lunch break when you feel insufficient sleep. Quit smoking and alcohol, avoid strong tea, coffee and other irritating drinks. Obese people control their weight.
Appropriate exercise: walking, jogging, Tai Chi, etc. are recommended. Do not do fulminant sports or activities, such as sudden jumping, turning, lifting heavy objects, holding children, opening wine bottles, holding objects, etc. You should stop immediately when you have difficulty breathing, chest pain, heart palpitations, dizziness, fatigue, sweating, pale complexion, and low blood pressure during exercise.
Prevention of infection: Maintain a suitable indoor temperature, increase or decrease clothing in time, avoid colds and colds, and avoid crowded places. Get influenza vaccine every year and pneumonia vaccine regularly.
Joyful mood: maintain a positive and optimistic attitude, combine work and rest, relax, and avoid anxiety and tension. Correctly understand the disease and actively cooperate with the treatment. Family members should give patients active support, help build confidence in overcoming the disease, and maintain emotional stability.
