UMEM Educational Pearls

Category: Cardiology

Title: fluid status and treatment of CHF

Keywords: congestive heart failure, CHF, pulmonary edema (PubMed Search)

Posted: 1/27/2008 by Amal Mattu, MD (Updated: 8/11/2022)
Click here to contact Amal Mattu, MD

Recent literature (Collins, et al, Ann Emerg Med, Jan 2008; and Cotter, et al, Am Heart J, Jan 2008) confirms something that we've been talking about for YEARS....more than 50% of patients presenting with acute cardiogenic pulmonary edema are not fluid overloaded, but rather have fluid mis-distributed into the lungs. Management should focus on fluid re-distribution rather than diuresis. Use of diuretics in these patients is associated with worsening renal function, which is a significant predictor of in-hospital mortality.

The best patients to use diuretics on are patients with slow progression of dyspnea, lower extremity edema, and weight gain over days-weeks. In the absence of a history of this slow progression, don't go crazy with the diuretics!