CH 51. Heart Failure and Meds

Heart failure

Progressive often fatal disorder, characterized by LV dysfunction, reduced cardiac output, insufficient tissue perfusion, and signs of fluid retention.

Left ventricular systolic dysfunction

Condition where the left ventricle weakens, leading to reduced ejection fraction and the heart's inability to pump enough blood to meet the body's needs.

Diastolic Heart Failure

Condition with normal LV ejection fraction but abnormal diastolic filling pattern.

Stage A Heart Failure

No symptoms of HF, no structural or functional cardiac abnormalities; the goal is to reduce risk through lifestyle changes and management of conditions.

Stage B Heart Failure

No symptoms of HF; the goal is to prevent the development of symptomatic HF.

Stage C Heart Failure

Symptoms of HF present with structural heart disease; the management focuses on relieving congestive symptoms and improving quality of life.

Stage D Heart Failure

Marked symptoms of HF with advanced structural heart disease; repeated hospitalizations may lead to consideration for heart transplant.

Diuretics

Medications (e.g., Loop, Thiazide, Potassium sparing) used to manage fluid retention in heart failure patients.

ACE inhibitors

Medications that inhibit the angiotensin-converting enzyme, leading to vasodilation, suppressed aldosterone release, and beneficial effects on cardiac remodeling.

Adverse effects of ACE inhibitors

Include hypotension, hyperkalemia, cough, angioedema, renal failure, and fetal injury.

angiotensin 2 receptor blockers

Reduce HF symptoms by improving ejection fraction

C  

1. spironolactone, inspra

2. Add to HF therapy in patients with moderate or severe symptoms

Why use aldosterone antagonists?

aldosterone causes water and sodium retention which leads to fluid overload and worsening heart function.

Beta Blockers

Medications that protect against dysrhythmias and excessive sympathetic stimulation in heart failure treatment.

adverse effects of beta blockers 

Hypotension, Fluid retention or worsening of HF, Fatigue, Bradycardia or Heart block

Dopamine [intropin]

Activates beta adrenergic receptors in heart, kidney and blood vessels . Increases Heart rate, Dilates renal vessels , Activates alpha 2 receptors  (Increase myocardial contractile force, Alter electrical activity of the heart, Favorably affect neurohormonal systems)

• Second line agents in HF treatment 

Dobutamine

Synthetic Catecholamine; Selective activation of beta 2 adrenergic receptors

Milrinone

A phosphodiesterase inhibitor that increases myocardial contractility and promotes vasodilation.

Digoxin

A cardiac glycoside used to increase myocardial contractility and cardiac output; requires careful monitoring of potassium levels.

Positive inotropic action

An effect that increases the force of cardiac muscle contraction, often seen with medications like digoxin.

Hypokalemia

A condition characterized by low potassium levels in the blood, which can exacerbate the effects of digoxin.

Neurohormonal benefits of Digoxin

Includes modulation of neurohormonal system activity, suppression of renin release, and decreased sympathetic outflow from the CNS.

Digoxin therapeutic range

The optimal therapeutic levels of digoxin, typically between 0.5 to 0.8.

Drug interactions with digoxin

Includes potential interactions with diuretics, ACE inhibitors, ARBs, dopamine, quinidine, and verapamil.