Therapeutic control of fluid balance in chronic heart failure

Andrew L. Clark, Alison P. Coletta and John G.F. Cleland

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI:

Series: Oxford Textbooks

Therapeutic control of fluid balance in chronic heart failure

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One of the cardinal clinical features of chronic HF (CHF) is fluidretention. Ankle swelling is one of the commonest presentationsleading to the diagnosis of heart failure (HF), and oedema is thestate that leads to the diagnosis of ‘congestive’ HF. Until the arrivalof thiazide and loop diuretics, the management of fluid retentionin HF was very limited. Tourniquets could be used to reduce preload, and Southey’s tubes, introduced by direct skin incision, were used to drain fluid. Venesection was a further option, and HFis perhaps one of the few instances where venesection proved helpful, at least in the short term.Digoxin provided some diuretic effect, particularly in those patients with atrial fibrillation and a rapid ventricular response, but the first specific diuretics available for use were the mercurial when mercury treatment for syphilis was noted to have a diuretic effect. Thiazide diuretics became available in the late 1950s andthe loop diuretic furosemide in the 1960srevolutionizing themanagement of HF.

Chapter.  9706 words.  Illustrated.

Subjects: Cardiovascular Medicine

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