[Therapy of coronary insufficiency with diuretics].

Saluretic drugs like thiazide and benzothiadiazine (chloruretic sulfonamides), potassium-sparing diuretics (amiloride, triamterene and spironolactone) and diuretics with an effect on the loop of Henle (furosemide, ethacrynic acid, bumetadine and etozoline) support the efficiency of digitalis preparations in such cases, in which the load of the heart may be diminished by hemodynamic disburdening of the myocardium through reduction of preload. Here, reduced venous filling pressure is the result of increased elimination of sodium and of dehydration. These drugs are efficacious, but can endanger the patient even if prescribed under right indication and by right dosage. Therefore they should be taken only if necessary and only under continuous medical supervision. The therapeutic breadth of the different diuretics is more favourable than that of the digitalis glycosides. Thus the careful prescription of diuretic drugs can enhance digitalization significantly, especially for patients of higher age with increased sensitiveness on heart glycosides or with supposedly "refractory" heart failure. A rapid intravenous injection of furosemide is the best method for the emergency treatment of an acute pulmonary edema in consequence of left heart failure. This is efficacious in a shorter time and in a better manner than an initial injection of heart glycosides. The favourable effect of diuretic drugs in myocardial failure may be explained by improving the force-velocity curve of the heart with reduction of preload of the myocardium and with diminished venous congestion.