Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis

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.