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Congestion and Use of Diuretics in Heart Failure and Cardiomyopathies: a Practical Guide

  • Myocardial Disease (A Abbate and M Merlo, Section Editors)
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A Correction to this article was published on 04 May 2023

This article has been updated

Abstract

Purpose of Review

Heart failure is a highly prevalent condition caused by many different aetiologies and characterised by cardiac dysfunction and congestion. Once developed, congestion leads to signs (peripheral oedema) and symptoms (breathlessness on exertion), adverse cardiac remodelling, and an increased risk of hospitalisation and premature death. This review summarises strategies that could enable early identification and a more objective management of congestion in patients with heart failure.

Recent Findings

For patients with suspected or diagnosed heart failure, combining an echocardiogram with assessment of great veins, lungs, and kidneys by ultrasound might facilitate recognition and quantification of congestion, the management of which is still difficult and highly subjective.

Summary

Congestion is a one of the key drivers of morbidity and mortality in patients with heart failure and is often under-recognised. The use of ultrasound allows for a timely, simultaneous identification of cardiac dysfunction and multiorgan congestion; ongoing and future studies will clarify how to tailor diuretic treatments in those with or at risk of heart failure.

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Acknowledgements

Fraser Graham has been awarded a research project grant from the British Heart Foundation (PG/2019/35089).

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Authors and Affiliations

  1. NHS Tayside, Dundee, UK

    Javed Khan & Chim C. Lang

  2. School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK

    Fraser J. Graham, Antonio Iaconelli, Jocelyn M. Friday & Pierpaolo Pellicori

  3. Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy

    Gabriele Masini

  4. Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy

    Gabriele Masini & Antonio Iaconelli

  5. Department of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK

    Chim C. Lang

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Pierpaolo Pellicori reports personal fees from Pharmacosmos, Vifor, and Caption Health, payment of honoraria from AstraZeneca, support from Pharmacosmos for attending meetings, outside the submitted work. Fraser Graham reports receipt of sponsorship from Pharmacosmos to attend an international meeting. Jocelyn Friday reports grants from British Heart Foundation (RE/18/6134217). The other authors declare that they have no conflict of interest.

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Khan, J., Graham, F.J., Masini, G. et al. Congestion and Use of Diuretics in Heart Failure and Cardiomyopathies: a Practical Guide. Curr Cardiol Rep 25, 411–420 (2023). https://doi.org/10.1007/s11886-023-01865-y

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