Drugs used in heart failure
Definition & classification
Heart failure is a clinical syndrome that results from an inability of the heart to maintain adequate
cardiac output. It is a progressive disorder associated with high morbidity and mortality. Prognosis is
generally poor; approximately 50% die within five years. A wide range of classifications reflects the
complexity of the condition.
Two Major Types of Failure:
Systolic Failure
Occurs as a result of reduced mechanical pumping action (contractility) and reduced cardiac
output and significantly reduced ejection fraction
Diastolic Failure
Occurs as a result of hypertrophy and stiffening of the myocardium and loss of adequate
relaxation playing a major role in reducing filling and cardiac output.
High-output Failure
Is a rare form of heart failure.
In this condition, the demands of the body are so great that even increased cardiac output is
insufficient.
High-output failure can result from hyperthyroidism and anemia
Signs and Symptoms of all Types of Heart Failure
Tachycardia
Decreased exercise tolerance
Shortness of breath (dyspnea)
Cardiomegaly
Peripheral and pulmonary edema (the congestion of congestive heart failure)
Compensatory Physiological Responses in HF:
1) Increased sympathetic activity.
2) Activation of the renin-angiotensin system
3) Myocardial hypertrophy compensations increase the work of the heart and lead to
further decline in cardiac performance.
Drug groups used in heart failure
, Decompensated HF:
If the adaptive mechanisms fail to maintain cardiac output, the HF is termed decompensated.
Chronic heart failure
Diuretics
Aldosterone receptor antagonist
Angiotensin-converting
enzyme inhibitors
Angiotensin receptor
Blockers
Beta blockers
Cardiac glycosides
Vasodilators
Acute heart failure
Diuretics
Vosodilators
Beta agonists
Bipyridines
Natriuretics
Peptide
Ace or Angiotensin Inhibitors:
Reduce peripheral resistance this lead to reduce afterload
Reduce salt and water retention (by reducing aldosterone secretion) and this lead to reduce
preload.
Reduction in tissue angiotensin levels also reduces sympathetic activity through diminution of
angiotensin’s presynaptic effects on norepinephrine release.
Reduce the long-term remodeling of the heart and vessels.
Angiotensin - Receptor Blockers
Definition & classification
Heart failure is a clinical syndrome that results from an inability of the heart to maintain adequate
cardiac output. It is a progressive disorder associated with high morbidity and mortality. Prognosis is
generally poor; approximately 50% die within five years. A wide range of classifications reflects the
complexity of the condition.
Two Major Types of Failure:
Systolic Failure
Occurs as a result of reduced mechanical pumping action (contractility) and reduced cardiac
output and significantly reduced ejection fraction
Diastolic Failure
Occurs as a result of hypertrophy and stiffening of the myocardium and loss of adequate
relaxation playing a major role in reducing filling and cardiac output.
High-output Failure
Is a rare form of heart failure.
In this condition, the demands of the body are so great that even increased cardiac output is
insufficient.
High-output failure can result from hyperthyroidism and anemia
Signs and Symptoms of all Types of Heart Failure
Tachycardia
Decreased exercise tolerance
Shortness of breath (dyspnea)
Cardiomegaly
Peripheral and pulmonary edema (the congestion of congestive heart failure)
Compensatory Physiological Responses in HF:
1) Increased sympathetic activity.
2) Activation of the renin-angiotensin system
3) Myocardial hypertrophy compensations increase the work of the heart and lead to
further decline in cardiac performance.
Drug groups used in heart failure
, Decompensated HF:
If the adaptive mechanisms fail to maintain cardiac output, the HF is termed decompensated.
Chronic heart failure
Diuretics
Aldosterone receptor antagonist
Angiotensin-converting
enzyme inhibitors
Angiotensin receptor
Blockers
Beta blockers
Cardiac glycosides
Vasodilators
Acute heart failure
Diuretics
Vosodilators
Beta agonists
Bipyridines
Natriuretics
Peptide
Ace or Angiotensin Inhibitors:
Reduce peripheral resistance this lead to reduce afterload
Reduce salt and water retention (by reducing aldosterone secretion) and this lead to reduce
preload.
Reduction in tissue angiotensin levels also reduces sympathetic activity through diminution of
angiotensin’s presynaptic effects on norepinephrine release.
Reduce the long-term remodeling of the heart and vessels.
Angiotensin - Receptor Blockers
