Furosemide Use in Coronary Artery Disease and Heart Failure

Clinical Context for Furosemide Use

The American Heart Association recommends furosemide for patients with acute severe hypertension and "flash" pulmonary edema, as initial therapy with intravenous nitroglycerin, furosemide, and a short-acting or intravenous ACE inhibitor is appropriate in patients presenting with acute coronary syndrome and pulmonary congestion 1
The American College of Cardiology suggests that in the acute setting with CAD and hypertension, diuretics are primarily used for patients with evidence of increased filling pressures, pulmonary venous congestion, or heart failure 1
The American Heart Association prefers loop diuretics such as furosemide over thiazides for heart failure with preserved or reduced ejection fraction, as they produce greater diuresis, work even in the presence of renal impairment, and have linear dose-response characteristics allowing escalation to high doses 2

The American College of Cardiology recommends combining furosemide with neurohormonal blockade, such as an ACE inhibitor or ARB, a β-blocker, and/or an aldosterone antagonist, to provide effective therapy and avoid adverse activation of the RAAS and sympathetic nervous system 2

The American Heart Association suggests that if tachycardia or ischemia is the predominant presentation without volume overload, intravenous esmolol together with intravenous nitroglycerin is usually the first choice rather than furosemide 1
The American College of Cardiology recommends preferring loop diuretics over thiazide diuretics in the acute setting with CAD when volume overload is present 1, 2