Acute HF Congestion: Practical Tips From ACC 2026 (Medscape Commentary) :
\n* \u201cNeck veins don\u2019t lie\u201d when assessing congestion.
\nKey bedside pearls for decongestion:
\n* Internal jugular venous waves remain one of the best clinical markers of right atrial pressure
\n\u2022\u2060 \u2060Important clinical message:
\nDo not stop diuresis solely because creatinine rises if the patient remains congested.
\n\u2022\u2060 \u2060Based on insights from the DOSE trial:
\n* Transient creatinine rise during aggressive diuresis may reflect hemodynamic changes due to transient decrease in intraglomerular pressure rather than true renal injury
\n* Persistent congestion may be more harmful than mild creatinine elevation.
\n* Potassium trends may be more clinically useful than creatinine alone :
\n* Normal potassium \u2192 often suggests preserved renal tubular function
\n* Rising potassium \u2192 raises concern for true renal dysfunction\/injury.
\n* Combination therapy (loop diuretic + spironolactone\/thiazide) may improve decongestion
\n\u2022\u2060 \u2060Additional practical tips:
\n* Avoid NSAIDs that impair diuretic response
\n* Continuous infusion loop diuretics may enhance fluid removal in hospitalized patients
\n* Monitor electrolytes closely during aggressive diuresis.<\/p>\n
Source: American College of Cardiology \/ Medscape
\nArticle: \u201cAsk the HF Expert: Managing Congestion\u201d
\nDate: May 5, 2026<\/p>\n