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Saturday 08 July 2006

Treating heart failure

By: David Kl Quek

Perhaps the most important medicine for various types of heart failure is the class of drugs known as diuretics, which are otherwise known as water pills.

The most widely used diuretic is frusemide (American furosemide, most commonly known as lasix), but others also used are bumetanide, spironolactone, amiloride, tiramterene, chlothalidone, hydrochlorothiazide, and so on.

These diuretics stimulate increased salt and water excretion by the kidneys (through a variety of mechanisms and different pathways), and thereby rid the excess fluid overload in the body.

Usually within half an hour of taking these diuretics, most patients will feel the need to urinate copious amounts of water several times over the next few hours. Often within hours or days, the patient for whom these diuretics work will feel better and less congested. The need to urinate frequently at night will also subside, with ease of lying flat to sleep, and nocturnal breathlessness should disappear.

However, because one of the necessary intra-cell salts (known as potassium) is also excreted together with the fluid, some decrease in the blood concentrations of this important chemical also takes place. Low potassium levels can lead to muscle cramps, and erratic and sometimes dangerous heart rhythms.

Thus some potassium salt replacement is usually also prescribed – or the patient is advised to take plenty of fruits which contain high amounts of potassium. Combining with or using a diuretic like spironolactone or amiloride or triamterene can help spare too much of potassium loss through the urine.

Other very important drugs now established for use in heart failure are those which counteract the hormonal excess associated with the syndrome. The Renin-Aldosterone-Angiotensin System (RAAS) is that system which has become over-stimulated in heart failure, to the point of harming the body’s preciously balanced organs such as the heart, the blood vessels, the kidneys.

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