The first manifestations of various heart diseases should be carefully examined in order to avoid the development of more dangerous symptoms. At tightening with the reference to the doctor the condition of a cardiac muscle gradually worsens. Its tissues and blood vessels undergo pathological changes and can no longer perform the functions of pumping enough blood. As a result, the patient is diagnosed with "heart failure", which is fraught with serious complications: myocardial infarction, ischemia, arterial hypertension, etc. Precisely, the timeliness of diagnosing the problems of the work of the heart will save you from dangerous consequences.
What is heart failure? Evolution of this disease occurs gradually, problems in the functioning of the heart grow with the age of the patient. In youth, he/she does not feel intermittent, because the heart tissues and blood vessels have sufficient tonus to supply blood to all parts of the body. Gradually, under the influence of various factors, tissues and blood vessels lose elasticity, the heart does not fulfill its basic function to the end and blood supply deteriorates.
How does Lasix help with heart failure?
Diuretic drugs, which action is based on the removal of excess fluid from the body, are used in the treatment of acute heart failure, as well as chronic conditions. In the first case, an intravenous form of medication is prescribed, among which the loop diuretic (lasix) is the most effective. In the chronic course of heart disease, a variety of diuretics, both chemical and vegetable, can be used.
The main task of the patient in this case is to control the amount of urine to be separated and to correct for possible electrolyte disorders.
Diuretics reduce preload and afterload on the heart, eliminate stagnation in the internal organs and peripheral edema. The effectiveness of their action depends on which department of the nephron they affect. The most potent diuretic is furosemide, since it acts throughout the loop of Henle, where the main reabsorption of sodium occurs.
Lasix causes a fast, powerful, but not a long-lasting diuretic effect. It has a pronounced withdrawal syndrome. The drug enhances the excretion of potassium, phosphate, calcium and magnesium, without affecting the speed of glomerular filtration, increases the excretion of bicarbonates and increases the pH of urine.
It can be used for kidney failure. Usually, the drug is administered inside of 20-240 mg / day., When administered its action starts after 1 hour and lasts 4-6 hours. When on / in effect after 10-15 minutes and lasts for 2-3 hours.
Standard scheme: the use of furosemide in CHF provides for taking the drug 1-2 times a week. In case of renal failure and in the absence of adequate diuresis, therapeutic doses last maximum dose of double and continue to double every 30-60 minutes to achieve the effect (sometimes up to 2-3 g per day).
Best time of day to take Lasix
The dose and course of therapy are set individually, taking into account the indications, the stage of the disease and the age of the patient. During the treatment, the dosage can be adjusted. The initial dose for adults of Lasix in tablets is 20-80 mg per day. The maximum dose is up to 600 mg per day.
For children, a single dose of 1-2 mg per kg of body weight, the maximum dose of 6 mg / kg. With intramuscular or intravenous administration, the dose for adults is 20-40 mg once a day, rarely 2 times a day. For children, the initial daily dose for parenteral use is 1 mg per 1 kg of body weight. The optimal speed of intravenous administration is no more than 4 mg per minute, for patients with severe renal failure 2.5 mg per minute.
Recommended dosing regimen for adults:
1. In edematic syndrome with chronic heart failure: 20-80 mg per day is divided 2-3 times.
2. With edematic syndrome with acute heart failure: 20-40 mg.
3. In case of edema with nephrotic syndrome: 20-40 mg per day.
Why are diuretics prescribed for heart failure?
The appointment of diuretics in heart failure helps to reduce the amount of intravascular fluid and reduce the severity of arterial hypertension. In addition, the venous return to the heart decreases. Due to this, the expression of interstitial edema and stagnation phenomena decrease. Some drugs have a direct effect on the cells of the vascular wall, reducing peripheral resistance, as well as sensitivity to vasopressors.
Depending on the mechanism of action of diuretics, several groups are distinguished:
• Loop diuretics are among the most effective drugs with a diuretic effect. Their action is directed to the ascending section of the loop of Henley, which is the structural unit of the nephron. In doing so, they significantly reduce the reverse absorption of sodium and chlorine ions, and enhance the excretion of potassium. As a result, the concentration capacity of the kidneys decreases, and the volume of the released fluid increases.
• Thiazide agents are also quite effective. They act mainly in the cortical section of the nephron loop, blocking the reabsorption of potassium and sodium in the ionic form. Against the background of taking drugs from the first two groups there is a risk of developing hypokalemia, which in some cases can be very serious.
• Potassium-sparing diuretics against the background of increased release of sodium ions lead to a delay in the body of potassium ions. They act mainly in the area of the distal tubules, where they transport these particles through the membrane. Their effectiveness is much lower than that of loop diuretics, but they are suitable for long-term use, because they do not lead to hypokalemia.
• Osmotic diuretics, affecting the composition of primary urine, in the treatment of heart failure are not used.
• Inhibitors of carbonic anhydrase inhibit the activity of the enzyme, resulting in reduced formation of carbonic acid. This decreases the reabsorption of sodium ions and increases the excretion of the liquid. The choice of a particular drug depends on the characteristics of the course of the disease, so you should agree on all the appointments with your doctor.
All chemical diuretics used in heart failure are often divided into several groups, depending on the strength of the diuretic effect. To potent diuretics, the following drugs refer: furosemide, ethacrylic acid, torasemide. Due to the fact that they are means for eliminating the symptoms of acute heart failure, they are released not only in tablets, but also in ampoules.
The solution with the drug can be administered intravenously in the form of continuous infusion or dropwise. This way of administration is the most optimal, and is suitable for effectively eliminating acute heart failure. In addition to acute situation, these diuretics are prescribed even during the decompensation of the chronic process. In this case, pills are used more often, and they are taken not every day, but 2-3 times a week.
Take into account that Furosemide results in increased excretion from the body of sodium and chloride and, as a consequence, water. In addition, excretion of other electrolytes (in particular, potassium, calcium and magnesium) is enhanced. Symptomatic abnormalities of electrolyte balance and metabolic alkalosis can change into a form of gradually increasing electrolyte deficiency.
When patients with normal liver function use higher doses of furosemide, acute deterioration of the patient's condition may occur due to a large loss of electrolytes.
Which drugs or supplements interact with furosemide?
The development of hypokalemia with the use of Lasix can lead to an increase in the action of cardiac glycosides. With the concomitant use of Lasix with glucocorticosteroids, laxatives, more careful monitoring of the electrolyte blood composition is required, since taking a combination of these drugs increases the risk of hypokalemia.
When combining Lasix with antibiotics of the cephalosporin series or aminoglycosides, it is possible to increase their level in the blood and, accordingly, increase the side effects. Probenecid, phenytoin and NSAIDs can reduce the diuretic effect of Lasix.
With the simultaneous administration of IACF and Lasix, it is possible to intensify the hypotensive effect, up to the development of collapse or decrease in the function of the kidneys and arteries. Combination of Lasix with antidiabetic means requires correction of the dose of the latter. Lasix is able to enhance the toxic effects of theophylline, lithium preparations and curare-like remedies.