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  • Spironolactone administration improved renal function through the normalization of the imbalance of vasoactive factors produced by CsA in acute and chronic nephrotoxicity models ( 16 ).
  • The importance of this second mechanism is still being debated. In addition there is experimental evidence that spironolactone’s antifibrotic effect may protect the matrix of the heart from unfavourable remodelling. 4 These include diminishing the ability of heart failure patients to respond to the demands of exercise by increasing both oxygen consumption and energy depletion.
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  • Chronic CHF is treated on an outpatient basis with sodium restriction, ACE inhibitors (first- line agents that reduce mortality rate), beta blockers (somewhat counterintuitive but proven to work), diuretics, spironolactone, digoxin (not used in diastolic dysfunction; usually reserved for moderate-to-severe CHF with low ejection fraction or systolic dysfunction), and vasodilators (arterial and venous). 38. How is acute congestive heart failure treated.
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