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2 . 2022

A clinical case of diuretic therapy-resistant edematous syndrome in an older patient with chronic heart failure and COVID 19


Patients with edematous syndrome are found in the clinical practice of various doctors specialties. Diuretics are an integral part of therapy for patients with chronic heart failure, pathologies of the liver or kidneys. However, adequate and effective treatment of edematous syndrome requires a differentiated approach to each individual patient, assessment and correction of various factors that could contribute to fluid retention. In the presented case a 74-year-old patient was admitted to the hospital with decompensated chronic heart failure against the background of COVID‑19 coronavirus infection. The examination revealed left-sided hydrothorax, hydropericardium, bilateral polysegmental viral pneumonia. Diuretics were used as part of complex therapy, which included glucocorticosteroids. However, the treatment of edematous syndrome with standard diuretic therapy was ineffective. After the correction of hypoalbuminemia, the appointment of replacement therapy with thyroid hormones, it was possible to achieve regression of hydropericardium, hydrothorax, and peripheral edema.

Keywords:edematous syndrome; chronic heart failure; diuretics; hypoproteinemia; hypothyroidism; coronavirus infection COVID 19

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Markelova E.S., Jakovlev A.A., Marzaeva E.V. A clinical case of diuretic therapy-resistant edematous syndrome in an older patient with chronic heart failure and COVID‑19. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2022. Т. 10, № 2. С. 60–6. DOI: (in Russian)


1. Emelina E.I. Management of patients with edematic syndrome // Rossiyskiy meditsinskiy zhurnal [Russian Medical Journal]. 2018; 23 (5): 259–6. (in Russian)

2. Trotsyuk D.V., Medvedev D.S., Makarenko S.V., Yushkova I.D., Lapotnikov A.V. Protein-energy malnutrition in elderly people. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2020; (2): 163. (in Russian)

3. Melnichenko G.A., Troshina E.A., Platonova N.M., et al. Iodine deficiency thyroid disease in the Russian Federation: the current state of the problem. Аnalytical review of publications and data of official state statistics (Rosstat). Consilium Medicum. 2019; 21 (4): 14–20. DOI: (in Russian)

4. Selimov A.Yu., Eliseeva L.N., Kurinnaya V.P., Oranskiy S.P. Glucose exchange disorders in patients taking glucocorticosteroids: features of clinical manifestations and correction. Kubanskiy nauchniy meditsinskiy vestnik [Kuban scientific medical bulletin]. 2019; 26 (1): 209–18. DOI: (in Russian)

5. Temporary methodical recommendations “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)”. Version 14 (27.12.2021) (approved by the Ministry of Health of Russian Federation). (in Russian)

6. Borisova E.O. Clinical pharmacology of glucocorticosteroids parenteral forms. Lechebnoe delo [Medical act]. 2007; (3): 17–24. (in Russian)

7. Khazova E.V., Bulashova O.V., Amirov N.B. Hypoalbuminemia and chronic heart failure. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of contemporary clinical medicine]. 2019; 12 (4): 80–5. DOI: (in Russian)

8. Muhin N.A., Fomin V.V., Pulin A.A. The problem of diuretic resistance: the causes and possible solutions. Spavochnik poliklinicheskogo vracha [Handbook for practitioners doctors]. 2011; 2: 29–32. (in Russian)

9. Dudinskaya E.N., Tkacheva O.N. Hypothyroidism in elderly and senile patients. Rossiyskiy meditsinskiy zhurnal. Meditsimskoe obozrenie [Russian Medical Journal. Medical Review. 2018; (8 (I)): 14–8. (in Russian)

Andrey G. Obrezan
MD, Professor, Head of the Hospital Therapy Department of the Saint Petersburg State University, Chief Physician of SOGAZ MEDICINE Clinical Group, St. Petersburg, Russian Federation
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