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Acute Vasoconstrictor Response to Intravenous Furosemide in Patients with Chronic Congestive Heart Failure: Activation of the Neurohumoral Axis

GARY S. FRANCIS, M.D.; ROBERT M. SIEGEL, M.D.; STEVEN R. GOLDSMITH, M.D.; MARIA TERESA OLIVARI, M.D.; T. BARRY LEVINE, M.D.; and JAY N. COHN, M.D.
[+] Article and Author Information

Grant support: by grants HL 22977-03 and HI 07184 from the National Heart, Lung, and Blood Institute, and a grant from the Veterans Administration Research Service. Dr. Goldsmith is a recipient of a Clinical Investigator Award from the National Institutes of Health.

▸Requests for reprints should be addressed to Gary S. Francis, M.D.; Cardiovascular Research (111C1), Veterans Administration Medical Center, 54th Street and 48th Avenue South; Minneapolis, MN 55417.


Minneapolis, Minnesota


© 1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;103(1):1-6. doi:10.7326/0003-4819-103-1-1
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Hemodynamic and neurohumoral responses to acute diuretic therapy were measured in 15 patients with severe chronic heart failure given intravenous furosemide, 1.3 ± 0.6 (SD) mg/kg body weight. Left ventricular pump function deteriorated by 20 minutes, as indicated by a fall in stroke volume index (27 ± 8 to 24 ± 7 mL/min · m2 body surface area, p < 0.01) and an increase in left ventricular filling pressure (28 ± 7 to 33 ± 9 mm Hg, p < 0.01). Increases occurred in heart rate (87 ± 13 to 91 ± 16 beats/min, p < 0.01), mean arterial pressure (90 ± 15 to 96 ± 15 mm Hg, p < 0.01), systemic vascular resistance (1454 ± 394 to 1676 ± 415 dynes · s· cm-5, p < 0.01), plasma renin activity (9.9 ± 8.5 to 17.8 ± 16 ng/mL · h, p < 0.05), plasma norepinephrine level (667 ± 390 to 839 ± 368 pg/mL, p < 0.01), and plasma arginine vasopressin level (6.2 ± 1.3 to 8.3 ± 2.0 pg/mL, p < 0.01). During the next 3.5 hours the patients had diuresis (2085 ± 1035 mL) and the expected fall in filling pressure (28 ± 7 to 22 ± 10 mm Hg, p < 0.01). Neurohumoral indicators also returned toward the control levels. Intravenous furosemide, in patients with severe chronic heart failure, is associated with acute pump dysfunction temporally related to activation of the neurohumoral axis.

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