Acute Decompensated HF with congestion - ESC Guideline Approach

Learning objectives:

Current guidelines regarding diuretic use in HF patients

Different mechanism of action of different diuretic agents

Using diuretics in real clinical practice

When to switch to mechanical fluid removal

Define future needs for new diuretic agents

Key points are actually interesting

1) measuring UNa+ @ 2 hours if no UOP >100 cc/hr. UNa+ has to be > 50 mEq/ L to make sure you actually achieve "natriuresis" ( poor fellow running around all night checking Una + levels !)
2) A rise in creatinine is to be expected in many cases and should not lead to backing off from diuresis. I think we see as soon as creatinine goes up MDs back off on diuresis , which is the exact wrong thing to if congestive symptoms are still present
3) Inotropes are discouraged , unless the patient has "true" low output symptoms...and dopamine is not on this list, milrinone is preferred. Any inotrope in the acute setting is associated with increased mortality and purely provides symptomatic relief.