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Treatment of Heart Failure

Max Wishnofsky, M.D.
JAMA. 1961;176(9):824. doi:10.1001/jama.1961.03040220072023.
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To the Editor:—  In the article on "Treatment of Heart Failure with Emphasis on the Use of Diuretics," in The Journal, Dec. 24, 1960, Dr. Charles K. Friedberg states: "Sooner or later diuretics are indicated in the treatment of all cases of heart failure."Diuretics, given alone, are far more powerful in removing the signs and symptoms of congestive heart failure than digitalis, rest, and restriction of sodium. If a patient with moderately severe, or severe congestive heart failure is given a powerful parenteral diuretic, a striking improvement of cardiac function occurs. The improvement in cardiac function as a result of the diuretics, unaided by digitalis, is so great that the fundamental conclusion must be drawn that the secondary metabolic manifestations, i.e., the accumulation of sodium and water, are far more potent in the production of congestive cardiac insufficiency than the primary system, that is cardiac incompetence itself. Thus, the


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