How to deal with diuretic resistance in heart failure treatment?

Although with the introduction of advanced medical technology from the West to China, China's medical technology has gradually developed, there are still many problems that cannot be solved by the medical community, such as: patients with heart failure have symptoms of diuretic resistance at the same time. In this case, the medicine prescribed by the doctor is often difficult to work well.

Because the most effective means of heart failure is to use diuretics, but patients are resistant to diuretics, which brings great difficulties to the disease. In this case, consider three solutions – limiting the patient's sodium and water intake, increasing the amount of diuretics, and combining multiple diuretics.

1. Limiting sodium and water intake is the so-called treatment of diseases from the source, and solving the problem of diuretic resistance is no exception. One of the causes of diuretic resistance is that patients with heart failure drink too much water or have too much diuresis for a long time, which leads to sodium retention, which in turn leads to diuretic resistance. In this case, limiting sodium and water intake can be a good solution to diuretic resistance.

2. Increase the dosage of diuretics According to the relevant studies on the pharmacokinetics of diuretics, as the condition of patients with heart failure progresses to a certain extent, patients will gradually become resistant to diuretics due to long-term use. At this time, increasing the dosage of diuretics can play a good role in compensating for the efficacy of the drug, which is conducive to alleviating the poor effect of the drug caused by diuretic resistance.

3. Combined use of a variety of diuretics Although the types of diuretics are very diverse, under normal circumstances, in order to avoid drug conflict, doctors will not use diuretics in combination**. However, current scientific research suggests that there are several diuretics that can have a synergistic effect. Therefore, patients who experience diuretic resistance may wish to use a combination of diuretics to increase their efficacy in relieving heart failure.

In summary, although the above three methods can solve the problem of diuretic resistance to a certain extent, they also have some drawbacks, such as: restricting water and sodium intake may disrupt the patient's body balance and cause other diseases; Increasing the dose of diuretics may further exacerbate diuretic resistance; Combination of multiple diuretics may cause electrolyte chaos in the patient's body and increase the risk of arrhythmias.

In the course of heart failure, sodium intake can be controlled if diuretic resistance is encountered; change the mode of medication to use intravenous drip or intravenous bolus; Combine the use of different diuretics and change to new antidiuretics; Doses of corticosteroids as appropriate; If refractory heart failure remains refractory, mechanical devices such as hemoperfusion** may be considered.

It may be that the kidney function is impaired, or it may be that the usual diet is salty, you can improve your eating habits, eat more light-tasting foods, or you can use drugs**, and use aldosterone receptor antagonists.

Sodium and water intake can be restricted, diuretics can be increased, or multiple diuretics can be used, all of which can be effective.

This is from the point of view of the pathology of both pathologies.

First of all, it is necessary to understand that the blood circulation of the human body is divided into systemic circulation and pulmonary circulation.

When the left heart fails, the arterial blood that enters the left atrium through the right heart circulation is more than the blood ejected through the left ventricle, so the anterior cardiac coincidence is enlarged, so the blood volume can be reduced by rapid diuretics and the cardiac preload can be reduced.

Diuretics can also be used to reduce cardiac workload when blood enters the left atrium through the right cardiopulmonary circulation in the case of right heart failure, resulting in left ventricular hypoejection and increased right ventricular pressure and systemic circulatory stasis. The decision to contradict diuretics should be based on clinical indicators and cannot be generalized.

Correct answer: c

De-disturbing and dispensing: Long-term use of diuretics is prone to electrolyte imbalance and acid-base imbalance, and is prone to low potassium, low magnesium and low sodium.

Liver function, kidney function, blood uric acid, blood sugar, etc. are generally abnormal.

Patients with heart failure.

Low blood pressure depends on it.

The specific situation of the patient, heart failure itself can cause hypotension, and one of the main ** items of heart failure is diuresis (cardiac, diuretic, anti.

infection, sedation, etc.,). Diuresis can alleviate the symptoms of heart failure and is good for heart failure, and drugs that can also have a cardiac effect are generally used to have a diuretic effect. In short, patients with heart failure with hypotension can use diuretics, and appropriate diuretics should be selected in combination with clinical symptoms. FYI.

Hello! Problem analysis: Heart failure is a decline in heart function, which is due to the organic changes that occur in the heart in a pathological state. It is necessary to strengthen the heart, reduce the burden on the heart, nutrition, etc., and the rhythm of the heart is good, and there is no need to install a pacemaker.

Suggestion: The installation of a pacemaker in patients with heart failure does not improve the patient's cardiac function. At present, patients need to identify the primary disease, and at the same time perform cardiac merger and disassembly, diuresis, oxygen inhalation, vasodilation, etc.

**Guidance: Attention should be paid to nutritional support**, nutritional support ** is the most important link, the heart does not have enough nutrients and protein can not work, this is to properly supplement meat food, high-protein and low-fat diet, even if the kidney function is not good, it is necessary to properly supplement high-protein and low-salt diet; Of course, you should also supplement foods such as vegetables and fruits. Severe edema can occur with insufficient protein.

There are also traditional Chinese medicines**: including many prescriptions, methods and so on, pay attention to diet and rest.

Diuretics** are mainly used to reduce the symptoms of edema. There are several types of diuretics, which are combined according to the degree of heart failure

Cyclic diuretics, such as nitrofuraniline, are generally used in mild heart failure.

Thiazides, such as hydrochlorothiazide, are used for mild heart failure.

Potassium-retained diuretics, such as amiloride, are used to correct hypokalemia.

Spironolactone is used for center of gravity failure.

Eplerenone is used to reduce risk to the heart muscle.

If patients with heart failure do not respond to diuretics or have little response, ultrafiltration or removal of water may be necessary to control edema. Through these means, the patient's response to traditional medicines can be reconstructed.

Application of diuretics. Diuretics improve heart function by excreting excess water and sodium, reducing circulating blood volume, reducing pulmonary congestion and generalized edema, and effectively reducing preload. But it does not enhance myocardial contractility and does not increase cardiac output.

Commonly used potassium-excreting diuretics are: furosemide, hydrochlorothiazide, etc.; Commonly used potassium-sparing diuretics are: spironolactone, triamterene, etc.