Congestion and use of diuretics in heart failure and cardiomyopathies: a practical guide

Purpose of the review: Heart failure is a highly prevalent condition caused by many different aetiologies and characterised by cardiac dysfunction and congestion. Once developed, congestion leads to signs (peripheral oedema) and symptoms (breathlessness on exertion), adverse cardiac remodelling, and an increased risk of hospitalisation and premature death. This review summarises strategies that could enable early identification and a more objective management of congestion in patients with heart failure.

Recent findings: For patients with suspected or diagnosed heart failure, combining an echocardiogram with assessment of great veins, lungs and kidneys by ultrasound might facilitate recognition and quantification of congestion, the management of which is still difficult and highly subjective.

Summary: Congestion is a one of the key drivers of morbidity and mortality in patients with heart failure and is often under-recognised. Use of ultrasound allows for a timely, simultaneous identification of cardiac dysfunction and multi-organ congestion; ongoing and future studies will clarify how to tailor diuretic treatments in those with or at risk of heart failure.