Question of the Day

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USMLE Step 2 Question of the Day

August 11, 2022

A 57-year-old male with systolic heart failure arrives at the emergency department with shortness of breath and swelling of his ankles. On physical exam, the patient is found to have 2+ pitting edema in both lower extremities. The patient is started on furosemide. In patients with systolic heart failure, medical therapy with furosemide is started to achieve which of the following?

Correct Answer: 

D. Improvement in symptoms by decreasing the fluid load

Explanation:

The correct answer is improvement in symptoms by decreasing the fluid load (choice D). Furosemide inhibits sodium/potassium/chloride reabsorption in the ascending loop of Henle and distal renal tubule, which leads to increased excretion of water. Symptomatic patients with heart failure experience relief from pedal and pulmonary edema secondary to the decreased water load. Physicians must maintain a delicate balance between symptom relief and adequate cardiac output as improper use of furosemide can be life-threatening.

Mortality is not affected by this therapy (choice B).

Furosemide therapy improves both pedal edema and pulmonary edema by decreasing the fluid load (choice C).

Furosemide therapy may actually increase the risk of arrhythmia from electrolyte abnormalities, especially hypokalemia (choice A).

If therapy with loop diuretics is too aggressive, cardiac output may decrease secondary to increased diuresis and hypovolemia (choice E).

Quick Concepts:

Furosemide in CHF

  • May provide symptomatic relief of pedal and pulmonary edema

Summary:

Furosemide allows symptomatic patients with heart failure to experience relief from pedal and pulmonary edema. Physicians must maintain a delicate balance between symptomatic relief and adequate cardiac output as improper use of furosemide can be life-threatening.

Correct Answer: 

D. Improvement in symptoms by decreasing the fluid load

Explanation:

The correct answer is improvement in symptoms by decreasing the fluid load (choice D). Furosemide inhibits sodium/potassium/chloride reabsorption in the ascending loop of Henle and distal renal tubule, which leads to increased excretion of water. Symptomatic patients with heart failure experience relief from pedal and pulmonary edema secondary to the decreased water load. Physicians must maintain a delicate balance between symptom relief and adequate cardiac output as improper use of furosemide can be life-threatening.

Mortality is not affected by this therapy (choice B).

Furosemide therapy improves both pedal edema and pulmonary edema by decreasing the fluid load (choice C).

Furosemide therapy may actually increase the risk of arrhythmia from electrolyte abnormalities, especially hypokalemia (choice A).

If therapy with loop diuretics is too aggressive, cardiac output may decrease secondary to increased diuresis and hypovolemia (choice E).

Quick Concepts:

Furosemide in CHF

  • May provide symptomatic relief of pedal and pulmonary edema

Summary:

Furosemide allows symptomatic patients with heart failure to experience relief from pedal and pulmonary edema. Physicians must maintain a delicate balance between symptomatic relief and adequate cardiac output as improper use of furosemide can be life-threatening.


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