Congestive Heart Failure

Diuretics may have considerable value in reducing the edema associated with congestive heart failure; however, each patient must be evaluated individually, since diuresis is not considered mandatory in all patients. Digitalis and salt restriction may be sufficient to decrease the associated symptoms of pulmonary congestion and peripheral edema. In patients who require a diuretic as adjunctive therapy, the usual choice should be a thiazide or thiazide-type diuretic rather than one of the loop diuretics (e.g., bumetanide or furosemide). This is true especially in mild congestive heart failure. The more efficacious compounds probably should be reserved for those who fail to respond to one of the thi-azides. A K+-sparing diuretic also can be given with the thiazide to maintain serum K+ levels, which might otherwise be depleted. Hypokalemia predisposes patients to digitalis intoxication.

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