Haemodynamic and electrocardiographic effects of frusemide during supine exercise in patients with angina pectoris.

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Abstract
The influence of frusemide on hemodynamic, ECG and symptomatic response to exercise was studied in 19 patients with documented coronary artery disease. During the control exercise period all patients experienced angina and showed ST segment depression, accompanied by raised pulmonary artery wedge pressures (PWP). In 12 of these patients 40 mg frusemide was administered i.v. and in the other 7 patients 40 mg frusemide was given orally. After significant diuresis (> 400 ml), the exercise test was repeated. Data were collected at the same exercise work load and duration as was achieved before frusemide. In the i.v. and oral group there was a reduction in cardiac output at rest and a less obvious reduction during exercise. The PWP during exercise after i.v. frusemide decreased from 32.9 to 11.8 mmHg and after oral frusemide from 30.7 to 15.7 mmHG. During the control period there was evidence of mitral regurgitation in 7 patients during angina, shown by high amplitude v waves in the PWP recordings. The alterations disappeared completely after the administration of frusemide. Ischemic ST depression improved in 15 of 19 patients after frusemide (0.21 vs. 0.09 mV) and there was a reduction of complete suppression of anginal pain in 18 of 19 patients; 10 patients were capable of continuing exercise for a further period of time at the same work load. The antianginal properties of frusemide reduce ventricular volumes and pressures, causing a decrease in myocardial wall stress and O2 demand. The effects may result from the diuretic action of frusemide and its venodilator capacity.