Mesto diuretika u terapiji hfref prema smernicama evropskih udruženja za lečenje akutne i hronične srčane insuficijencije

Abstract

Heart failure is a clinical syndrome which can be manifested by structure and/or functional heart abnormality (LVEF is < 50%, pericardial cavity dilatation, E/E'> 15, moderate to severe hypertrophic cardiomyopathy and/or aortic valve stenosis or regurgitation) corroborated by elevated natriuretic peptides and/or objective indicators of pulmonary or systemic congestion. Based on a research data of hospitalized patients with heart failure, it is registered that the most frequent form is HFrEF, in 50% of the patients, whereas HFmrEF and HFpEF is registered in the other 50% of the patients. Today, the most common cause of heart failure is coronary artery disease. Prognosis of the patients with heart failure nowadays is much better when compared to the results of the first studies and researches. There are two types of heart failure based on the clinical presentation: acute and chronic heart failure. Heart failure is diagnosed based on the symptoms and/or signs of heart failure as well as objective indications of cardiac dysfunction. The goal of cardiac insufficiency with lowered LVEF treatment is the modulation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system. New group of medications, such as SGLT2, are introduced and recommended in treatment of heart failure. Diuretics have an essential role in treating patients with congestion. When treating with diuretics, the goal is to maintain euvolemic state by administering the lowest dosages of these drugs. Loop diuretics have the best effect on symptom reduction, congestion reduction and improvement in physical exertion. Beside loop diuretics, MRA is also a part of the therapy. The diuretic effect achieved by spironolactone and eplerenone is weak. These medications block aldosterone receptors. RALES study showed that administering spironolactone in patients with HFrEF leads to a significant morbidity and mortality reduction. In the past decade, there was a major breakthrough in the treatment of the patients with cardiac insufficiency by introducing modern medications which reduced mortality and the need for repeated hospitalizations caused by heart failure. Diuretic therapy has important role in treatment of patients with heart failure leading to reduction of congestion and better quality of life.