Which mechanism explains why NSAIDs worsen heart failure?

Which mechanism explains why NSAIDs worsen heart failure?

• A. Improved diuresis and lowered blood pressure.
• B. Decreased vascular resistance.
• C. Increased cardiac contractility.
• D. Fluid retention and renal impairment.

Answer: (D)

The key idea is that NSAIDs worsen heart failure by causing fluid retention through renal effects. NSAIDs inhibit prostaglandin production in the kidneys, which normally helps dilate the afferent arteriole and maintain renal perfusion. With fewer prostaglandins, afferent arteriolar constriction reduces glomerular filtration rate and promotes sodium and water retention. The resulting increase in blood volume raises preload and can worsen edema and heart failure symptoms. This renal-mediated fluid retention can also blunt the effectiveness of diuretics and other HF therapies. Other options would not explain the worsening of heart failure with NSAIDs. Improved diuresis and lowered blood pressure would help HF, decreased vascular resistance would typically ease afterload, and NSAIDs do not increase cardiac contractility as a mechanism for HF worsening. The adverse renal effect leading to fluid retention best explains why NSAIDs are harmful in heart failure.

The key idea is that NSAIDs worsen heart failure by causing fluid retention through renal effects. NSAIDs inhibit prostaglandin production in the kidneys, which normally helps dilate the afferent arteriole and maintain renal perfusion. With fewer prostaglandins, afferent arteriolar constriction reduces glomerular filtration rate and promotes sodium and water retention. The resulting increase in blood volume raises preload and can worsen edema and heart failure symptoms. This renal-mediated fluid retention can also blunt the effectiveness of diuretics and other HF therapies.

Other options would not explain the worsening of heart failure with NSAIDs. Improved diuresis and lowered blood pressure would help HF, decreased vascular resistance would typically ease afterload, and NSAIDs do not increase cardiac contractility as a mechanism for HF worsening. The adverse renal effect leading to fluid retention best explains why NSAIDs are harmful in heart failure.