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Exploring Neurohormonal Modulation by Acetazolamide in Heart Failure.
Cureus
December 2024
Gastroenterolgy, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Background Heart failure (HF) is commonly managed by addressing water and sodium (Na) balance, with arterial circulation playing a major role in influencing renal Na and water excretion. Recently, chloride (Cl) has been recognized as an important factor in HF, associated with volume regulation and its modulation of renin-angiotensin-aldosterone system (RAAS) activity through macula densa signaling, which impacts Na retention and neurohormonal activation. Acetazolamide, a carbonic anhydrase inhibitor, can enhance decongestion in HF by increasing urinary Na and Cl excretion when added to loop diuretics, a mechanism supported by prior studies demonstrating improved urine output and decongestion.
View Article and Find Full Text PDFEfficacy of Oral Acetazolamide as Add-on Diuretic Therapy in Decongestion in Patients with Heart Failure: A Study Protocol for a Randomized Controlled Trial.
J Tehran Heart Cent
January 2024
Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Background: Acute heart failure is a common clinical syndrome leading to hospital admission, with few evidence-based therapies for managing congestion. This trial aims to assess the efficacy of acetazolamide combined with loop diuretics in achieving decongestion among patients who fail to respond to oral diuretics and progress to acute decompensated heart failure in the absence of injectable furosemide.
Methods: This single-center, double-blind randomized controlled trial with a 1:1 allocation ratio aims to evaluate 130 patients admitted to the infusion ward.
Rationale and Design of the DECONGEST (Diuretic Treatment in Acute Heart Failure With Volume Overload Guided by Serial Spot Urine Sodium Assessment) Study.
J Card Fail
August 2024
Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address:
Aims: To evaluate whether early-combination diuretic therapy guided by serial post-diuretic urine sodium concentration (UNa) assessments in acute heart failure (AHF) facilitates safe and effective decongestion.
Methods: The Diuretic Treatment in Acute Heart Failure with Volume Overload Guided by Serial Spot Urine Sodium Assessment (DECONGEST) study is a pragmatic, 2-center, randomized, parallel-arm, open-label study aiming to enroll 104 patients with AHF and clinically evident fluid overload requiring treatment with intravenous loop diuretics. Patients are randomized to receive standard of care or a bundled approach comprising: (1) systematic post-diuretic UNa assessments until successful decongestion, defined as no remaining clinical signs of fluid overload with a post-diuretic UNa ≤ 80 mmol/L; (2) thrice-daily intravenous loop diuretic bolus therapy, with dosing according to estimated glomerular filtration rate; (3) upfront use of intravenous acetazolamide (500 mg once daily [OD]); and (4) full nephron blockade with high-dose oral chlorthalidone (100 mg OD) and intravenous canreonate (200 mg OD) for diuretic resistance, defined as persisting signs of fluid overload with a post-diuretic UNa ≤ 80 mmol/L.
Bilateral simultaneous acute angle closure glaucoma triggered by an over-the-counter cold and influenza medication.
BMJ Case Rep
August 2024
Ophthalmology, University Hospitals of Leicester NHS Trust, Leicester, UK.
A woman in her mid-60s who is a high hypermetrope presented with bilateral eye pain and headache approximately 1 hour after taking a single dose of a widely available decongestant containing paracetamol, guaifenesin and phenylephrine hydrochloride for coryzal symptoms. She had previous successful bilateral peripheral iridotomies performed for narrow angles. At presentation, her intraocular pressures (IOPs) were significantly raised at 72 mm Hg and 66 mm Hg in the right and left eye, respectively, with bilateral corneal oedema.
View Article and Find Full Text PDFSerum Chloride and the Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload: A Post Hoc Analysis From the ADVOR Trial.
Circ Heart Fail
October 2024
Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium (F.H.V.).
Article Synopsis
- The study explores the relationship between serum chloride levels and clinical outcomes in patients with acute heart failure undergoing treatment with acetazolamide, highlighting its role in renal salt sensing.
- Results showed that low chloride levels (hypochloremia) were linked to slower recovery, longer hospital stays, and higher risks of mortality and readmissions, while high chloride levels (hyperchloremia) were also noted but less common.
- Acetazolamide was found to improve decongestion and prevent chloride levels from dropping, aiding patients regardless of their initial serum chloride status, which suggests its potential benefits in managing heart failure.
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