The Curious Clinicians [Archive] The Fast and the Furosemide
Sep 4, 2024
Discover the rapid relief furosemide provides for pulmonary edema in heart failure. Learn how this medication alleviates dyspnea almost instantly, with mechanisms beyond just diuresis. Explore historical studies that showcase its venodilatory effects and how it impacts left ventricular filling pressures. Delve into the interplay of furosemide and prostaglandins, revealing potential benefits even in cancer-related dyspnea. This fascinating discussion highlights the clinical implications of furosemide's diverse actions in acute congestive heart failure.
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Immediate Patient Improvement Surprise
- Tony Brew experienced immediate patient improvement after IV furosemide before urine appeared.
- He initially took credit without understanding the mechanism, illustrating common clinical surprise.
Venodilation Lowers LV Pressure Fast
- Furosemide causes rapid venodilation increasing venous capacitance within five minutes.
- This venodilation lowers left ventricular filling pressures, improving dyspnea before diuresis starts.
Prostaglandins Mediate Venodilation
- Furosemide's venodilation is mediated by prostaglandins, proven by indomethacin blocking its effects in animal studies.
- This implicates prostaglandin activity as key to furosemide's immediate hemodynamic benefits.