Acute HF Congestion: Practical Tips From ACC 2026 (Medscape Commentary) :
Acute HF Congestion: Practical Tips From ACC 2026 (Medscape Commentary) :
* “Neck veins don’t lie” when assessing congestion.
Key bedside pearls for decongestion:
* Internal jugular venous waves remain one of the best clinical markers of right atrial pressure
• Important clinical message:
Do not stop diuresis solely because creatinine rises if the patient remains congested.
• Based on insights from the DOSE trial:
* Transient creatinine rise during aggressive diuresis may reflect hemodynamic changes due to transient decrease in intraglomerular pressure rather than true renal injury
* Persistent congestion may be more harmful than mild creatinine elevation.
* Potassium trends may be more clinically useful than creatinine alone :
* Normal potassium → often suggests preserved renal tubular function
* Rising potassium → raises concern for true renal dysfunction/injury.
* Combination therapy (loop diuretic + spironolactone/thiazide) may improve decongestion
• Additional practical tips:
* Avoid NSAIDs that impair diuretic response
* Continuous infusion loop diuretics may enhance fluid removal in hospitalized patients
* Monitor electrolytes closely during aggressive diuresis.
Source: American College of Cardiology / Medscape
Article: “Ask the HF Expert: Managing Congestion”
Date: May 5, 2026
https://www.medscape.com/viewarticle/ask-hf-expert-managing-congestion-2026a1000ddv