There are many hemodynamic faces of
heart failure, ranging from the subclinical to the terminal syndrome. The
diuretics possess, with minor qualification, the pharmacotherapeutic attributes of the ideal first-line
drug of choice. In
heart failure, the
loop diuretics have achieved eminence due to their improvement of the deranged hemodynamic profile without significant adverse pharmacologic effects. The new
loop diuretics, including
torasemide, have been shown to reduce the raised pulmonary vascular pressures without significant depression of the cardiac output in patients with chronic
heart failure. This hemodynamic improvement has been paralleled by a significant improvement in clinical symptoms in the majority of patients. The undoubted and widely accepted efficacy of the
loop diuretics in all the
heart failure syndromes have presented a formidable ethical obstacle to their formal testing in terms of improvement in exercise capacity and reduction of mortality risk. There is still a paucity of information on their singular impact on the excited neuroendocrine reflexes in
heart failure and their influence on the widespread metabolic disturbances occasioned by pumping failure of the heart. From the clinical standpoint, however, these deficiencies in information do nothing to reduce the importance of the
loop diuretics in the treatment of acute and chronic
heart failure.