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Outcomes in patients treated with loop diuretics without a diagnosis of heart failure: a retrospective cohort study
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  • Published on:
    Diagnostic opportunities generated by a trial of loop diuretic treatment

    A trial of loop diuretic therapy in patients who have not received the benefit of evaluation either by echocardiography or by natriuretic peptide testing can be an opportunity to maximise alternative strategies for validating the diagnosis of congestive heart failure(CHF)
    The following are some of the alternative strategies:-
    (1)Evaluation of jugular venous pressure(JVP).
    This strategy was poorly maximised in the anecdotal report of two patients(patient 2 and patient 3) ,with peripheral oedema and breathlessness, in whom the initial cardiovascular examination was recorded as "normal". A subsequent repeat clinical examination revealed an extremely elevated JVP attributable to constrictive pericarditis[1].
    Documentation of body weight before and after a trial of loop diuretic treatment enhances the diagnostic value of evaluation of JVP. The rationale is that a JVP that is persistently high in spite of significant weight loss after diuretic use can be a powerful indicator of the diagnosis of constrictive pericarditis[2]]
    (ii) Documentation of a fall in forced vital capacity(FVC) after a trial of loop diuretic treatment.
    In that context, a fall in body weight which is accompanied by a fall in FVC after a trial of loop diuretic treatment is indicative of a reversible restrictive ventilatory defect that is attributable to pulmonary congestion and, hence, CHF. Reversibility of FVC after loop diuretics is a well document...

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    Conflict of Interest:
    None declared.