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Volume Assessment and Management: Medical and Device Therapies

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Pharmacologic Trends of Heart Failure

Part of the book series: Current Cardiovascular Therapy ((CCT))

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Abstract

Heart failure patients retain sodium and fluid and may develop congestive symptoms of dyspnea, fatigue, and peripheral edema. Congestion is associated with increased morbidity and mortality in heart failure patients. Thus, the clinician should routinely assess for evidence of clinical congestion based on history and physical examination. In addition, laboratory and imaging modalities as well as more recently developed implantable device technologies may assist with the diagnostic evaluation of congestion. The management of congestion has historically been based on loop diuretics, however, additional pharmacologic therapies such as thiazide diuretics, vasodilators, vasopressin antagonists, and mineralocorticoid receptor antagonists may provide additional decongestion benefits. If diuretic-based therapies are unsuccessful, ultrafiltration may be considered but should be used with caution in the setting of cardiorenal syndrome. In this chapter, we review the assessment of clinical congestion and highlight recent device-based diagnostic technologies. The approach to volume management is outlined including both pharmacologic and mechanical fluid removal.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Lauren B. Cooper MD & Robert J. Mentz MD

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  1. Lauren B. Cooper MD
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Correspondence to Lauren B. Cooper MD .

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  1. Department of Cardiology, Ochsner Health System, New Orleans, Louisiana, USA

    Hector O. Ventura

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Cooper, L.B., Mentz, R.J. (2016). Volume Assessment and Management: Medical and Device Therapies. In: Ventura, H. (eds) Pharmacologic Trends of Heart Failure. Current Cardiovascular Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-30593-6_4

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