Heart failure (HF) is a syndrome defined by the failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolising tissues, despite normal filling pressures (or only at the expense of increased filling pressures),1 secondary to an abnormality of the cardiac structure or function.
HF is the most common cause of hospitalisation in patients over the age of 65.2 The main manifestations of the syndrome are symptoms resulting from vascular congestion, such as shortness of breath, abdominal distension, oedema formation and symptoms resulting from low systemic perfusion. HF syndrome is of relevant economic importance and in the ADHERE study signs and symptoms of congestion were the most frequent cause of hospital admission.1 Congestion often develops gradually before admission and many patients may have elevated left ventricular (LV) filling pressures even when congestion (dyspnoea, jugular venous distension or oedema)3 is absent. Diuretic therapy, and especially loop diuretic therapy, are the usual way of managing congestion, especially in volume- overloaded patients.4 The most commonly used diuretics in HF are loop diuretics, thiazides and potassium-sparing diuretics.
This review focuses on the classes of diuretics, their role in cases of HF with volume overload and current approaches when treating this complex subset of patients.