Medication Summary
With few exceptions (eg, acute right ventricular myocardial infarction), diuresis is the cornerstone of initial management of cardiac cirrhosis. As cardiac cirrhosis is a direct complication of elevated central venous pressures, effective diuresis should improve hepatic derangements. Lack of improvement should prompt a search for primary hepatic disease.
Beyond diuretics, medical therapy should be directed at treating underlying heart failure and correcting the source of elevated right-sided heart pressures.
Diuretics
Class Summary
Initial treatment of cardiac cirrhosis usually requires a loop diuretic (eg, furosemide). Spironolactone may provide additional diuresis through its aldosterone antagonism effects.
Furosemide (Lasix)
Increases excretion of water by interfering with chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule.
Initial administration should be IV to avoid poor bowel absorption through edematous bowel mucosa. Start dosing low and increase to achieve desired diuresis and clinical effect. Useful clinical target is return to patient's baseline weight.
Rising serum BUN and creatinine levels are indicators of prerenal azotemia and suggest maximal diuresis has been achieved. Once determined, administer effective dose qd or bid.
Spironolactone (Aldactone)
For management of edema resulting from excessive aldosterone levels secondary to hepatic cirrhosis or CHF. Competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.
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Cardiac cirrhosis and congestive hepatopathy. Congestive hepatopathy with large renal vein.
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Cardiac cirrhosis and congestive hepatopathy. Congestive hepatopathy with large inferior vena cava.
