Edema in heart failure
Fluid retention and peripheral edema from impaired cardiac pumping. Loop diuretics are the mainstay of symptomatic relief. They do not prolong life but rapidly relieve dyspnea and edema.
ICD-10 I50.92 drugs
Also known as: Congestive heart failure with edema
Drugs used for this condition
- AFurosemideFirst line · Loop diureticsIn symptomatic HF with congestion, first-line for symptom control alongside the four pillars of ESC HF 2021 (ACEi/ARNI, beta-blocker, MRA, SGLT2i). Start 20–40 mg orally once or twice daily, titrate to symptoms and weight. Diuretics do not reduce mortality in HF but improve dyspnea, edema, and reduce hospitalizations. Use the lowest effective dose.
- BHydrochlorothiazideSecond line · Thiazide diureticsFor mild-to-moderate edema in HF, thiazides can complement loop diuretics. In severe HF and eGFR < 30 mL/min/1.73 m², thiazides lose efficacy – loop diuretics (furosemide, torsemide) are preferred. For diuretic-resistant edema, a thiazide is combined with a loop diuretic for 'sequential nephron blockade'.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit