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Zaključak

U protekloj deceniji napravljen je veliki korak u lečenju bolesnika sa srčanom insuficijencijom
uvođenjem modernih lekova koji su redukovali mortalitet i potrebu za ponavljajućim hospitalizacijama
zbog srčane insuficijencije. Diuretska terapija zauzima i dalje značajno mesto u lečenju svih oblika
srčane insuficijencije u cilju redukcije simptoma kongestije i unapređenja kvaliteta života.

Abstract
Heart failure is a clinical syndrome which can be manifested by structure and/or functional heart abnormality (LVEF
is < 50%, pericardial cavity dilatation, E/E’> 15, moderate to severe hypertrophic cardiomyopathy and/or aortic valve
stenosis or regurgitation) corroborated by elevated natriuretic peptides and/or objective indicators of pulmonary or
systemic congestion. Based on a research data of hospitalized patients with heart failure, it is registered that the most
frequent form is HFrEF, in 50% of the patients, whereas HFmrEF and HFpEF is registered in the other 50% of the patients.
Today, the most common cause of heart failure is coronary artery disease. Prognosis of the patients with heart failure
nowadays is much better when compared to the results of the first studies and researches. There are two types of
heart failure based on the clinical presentation: acute and chronic heart failure. Heart failure is diagnosed based on
the symptoms and/or signs of heart failure as well as objective indications of cardiac dysfunction. The goal of cardiac
insufficiency with lowered LVEF treatment is the modulation of renin-angiotensin-aldosterone system (RAAS) and
sympathetic nervous system. New group of medications, such as SGLT2, are introduced and recommended in treatment
of heart failure. Diuretics have an essential role in treating patients with congestion. When treating with diuretics, the
goal is to maintain euvolemic state by administering the lowest dosages of these drugs. Loop diuretics have the best
effect on symptom reduction, congestion reduction and improvement in physical exertion. Beside loop diuretics, MRA
is also a part of the therapy. The diuretic effect achieved by spironolactone and eplerenone is weak. These medications
block aldosterone receptors. RALES study showed that administering spironolactone in patients with HFrEF leads to a
significant morbidity and mortality reduction.

In the past decade, there was a major breakthrough in the treatment of the patients with cardiac insufficiency by
introducing modern medications which reduced mortality and the need for repeated hospitalizations caused by heart
failure. Diuretic therapy has important role in treatment of patients with heart failure leading to reduction of congestion
and better quality of life.

Keywords: diuretics, heart failure with reduced ejection fraction, therapy

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