Re: Cardiomyopathy

Posted By CCF CARDIO-MD sc on September 01, 1997 at 07:12:23:

In Reply to: Cardiomyopathy posted by Dallas on August 27, 1997 at 14:14:20:







: What do diuretic medications do to a person's body/organs after long term use??  What IS considered long term use?  Should one reduce their fluid intake when taking diuretics on top of reducing their salt/sodium intake?  Also, is the EJECTION FRACTION rate a good indication of a patient's heart's FUNCTIONING ABILITY as the result of a virus-caused Cardiomyopathy?  Thanks for this wonderful forum? Dallas



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Dear Dallas
Thank you for the very salient questions which I am sure will be of interest to many people apart from yourself. I will attempt to answer one question at a time. Diuretic therapy has played an important part in the treatment of congestive heart failure because of the central role of the kidney as the target organ of many of the biological changes that take place in the body as a result of a failing heart. Diuretics improve symptoms of heart failure by preventing salt ( plus other solutes ) and subsequently water absorption by the kidney  and possible slowing the progression of cardiac chamber dilation by reducing left ventricular filling pressures ( because of the decreased volume in the circulation  ). I would like to add however Diuretics do not influence the natural history and progression of the underlying heart disease responsible for  the heart failure in the first place. There are many different groups of diuretics each with its own side effect profile. However there seem to no clear specific side effect profile related to long term use that is different from the side effects that may be seen on initiation of therapy. Having said this I would like to clarify that certain classes of diuretics namely the thiazide group, may induce glucose intolerance ( a diabetes like state ) possibly as a result of some insulin resistance , with  some individuals even developing the typical picture of adult onset diabetes. If this is not taken care of there may  possible be long term complications from the increased insulin resistance. This same class of drug, the thiazides have also been noted to have an unfavorable side effect on plasma lipids with modest changes in total cholesterol, triglyceride levels, and/or LDL cholesterol of at least 1-5%, the clinical importance of these side effects are however questioned when taking into consideration the their proven efficacy ( especially in hypertension ), their minimal side effect profile, and their low cost, especially when these side effects can be offset by other maneuvers.
Fluid restriction may also be an integral part in the treatment of congestive heart failure. It really depends on a balance between the input and output to try and stay at a stable  dry weight. This is the weight that your doctors determine to be your weight when you are well compensated with no " extra fluid " in your system . The question of the degree of fluid restriction depends on the individual clinical  scenario and will need to be determined after a clinical evaluation.
Left ventricular ejection fraction or left ventricular emptying fraction is a means of quantifying left ventricular  systolic function. There are different means of obtaining this value, description of which go beyond the scope of this discussion. The ejection fraction is ultimately obtained by dividing the end systolic by the end diastolic volumes and multiplying by 100 for a percentage. There are certain conditions, specifically leaking valves on the left side of the heart, and left to right shunts  ( eg VSD, coronary fistula )where the Ejection Fraction may be high but the actual forward flow which contributes to the actual cardiac output is lower. If measured correctly and if none of the confounding factors are present the Ejection Fraction is together with other variables has been shown to correlate with survival in patients with heart failure. Although in some way related the ejection fraction does not always correlate accurately with a patients symptoms which are effected by other biological conditions.
I hope this has helped clarify some of you questions, if you have any further questions or would like to be seen by our Heart Failure Group here at The Cleveland Clinic please feel free to call 1-800-CCF-CARE for an appointment.
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).