BATCH
PHARMACOLOGY B | DRUGS USED IN ANGINA
Drugs Used in Heart Failure 2020
COLLEGE OF MEDICINE
Heart failure occurs when cardiac output is inadequate to
provide the oxygen needed by the body.
Most common cause of heart failure in the USA is coronary
artery disease, with hypertension also an important factor.
Heart failure is a progressive disease that is characterized by a BATCH
gradual reduction in cardiac performance, punctuated in many
cases by episodes of acute decompensation, often requiring
hospitalization.
Two major types of failure:
1. Systolic failure
~50% in younger patients
reduced mechanical pumping action (contractility) and
reduced ejection fraction.
2. Diastolic failure
with stiffening and loss of adequate relaxation playing a
major role in reducing filling and cardiac output.
Ejection fraction may be normal (preserved) in diastolic
failure even though stroke volume is significantly reduced.
the proportion of patients with diastolic failure increases
with age.
Treatment goals:
(1) reducing symptoms and slowing progression as much as possible
during relatively stable periods
(2) managing acute episodes of decompensated failure
Therapies used in heart failure
Chronic Systolic Heart Failure Acute Heart Failure
Diuretics Diuretics
Aldosterone receptor antagonists Vasodilators
Angiotensin-converting enzyme Beta agonists
inhibitors Bipyridines
Angiotensin receptor blockers Natriuretic peptide
Beta blockers Left ventricular assist device
Cardiac glycosides
Vasodilators
Resynchronization therapy
Although it is believed that the primary defect in early systolic heart
failure resides in the excitation-contraction coupling machinery of
the myocardium, the clinical condition also involves many other
processes and organs, including the baroreceptor reflex, the
sympathetic nervous system, the kidneys, angiotensin II and other
peptides, aldosterone, and apoptosis of cardiac cells
therapy directed at noncardiac targets is more valuable in the long-
term treatment of heart failure than traditional positive inotropic
agents (cardiac glycosides [digitalis]).
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin
receptor blockers (ARBs), certain β blockers, aldosterone receptor
antagonists, and combined hydralazine-nitrate therapy are the only
agents in current use that
actually prolong life in patients with chronic heart failure. These
strategies are useful in both systolic and diastolic failure. Positive
inotropic drugs, on the other hand, are helpful mainly in acute
systolic failure. Cardiac glycosides also reduce symptoms in chronic
systolic heart failure. In large clinical trials to date, other positive
inotropic drugs have usually reduced survival in chronic failure or
had no benefit, and their use is discouraged.
