Heart Failure Medications

Heart Failure Medications and Their Mechanisms

• ACE inhibitors and ARBs are first-line therapies for heart failure, reducing preload and afterload, and improving cardiac remodeling, with side effects including hyperkalemia, cough, and angioedema.
• Beta antagonists such as metoprolol and carvedilol inhibit beta-adrenergic receptors, improving symptoms and decreasing mortality, with dosage being critical and titration necessary.
• Ivabradine, a funny sodium channel blocker, decreases heart rate without affecting contractility or intracardiac conduction, and is approved for patients with chronic HF with reduced ejection fraction and high resting heart rate.
• Diuretics, including loops, thiazides, and aldosterone receptor antagonists, reduce extracellular fluid volume and ventricular filling pressures, with aldosterone antagonists also blocking cardiac remodeling.
• SGLT2 inhibitors, Dapagliflozin and Empagliflozin, reduce the risk of hospitalization for heart failure and cardiovascular death, improving left ventricular loading conditions and promoting weight loss.
• Inotropic drugs, including digoxin, increase intracellular Ca++ and force of contraction, and are preferred in heart failure with concurrent atrial fibrillation or for patients not responding to standard therapies.
• Digoxin has a half-life of 36-48 hours, and its major side effect is digitalis toxicity, with predisposing factors including hypokalemia and certain drugs.
• Treatment of severe digoxin toxicity involves anti-digoxin antibodies, such as Digibind.
• RAAS inhibitors include ACE inhibitors like enalapril and lisinopril, and ARBs like losartan and valsartan.
• Beta antagonists like metoprolol and carvedilol inhibit beta-adrenergic receptors, improving symptoms and decreasing mortality, with dosage being critical and titration necessary.
• Ivabradine, a funny sodium channel blocker, decreases heart rate without affecting contractility or intracardiac conduction, and is approved for patients with chronic HF with reduced ejection fraction and high resting heart rate.
• SGLT2 inhibitors, Dapagliflozin and Empagliflozin, reduce the risk of hospitalization for heart failure and cardiovascular death, improving left ventricular loading conditions and promoting weight loss.

Heart Failure: Symptoms, Diagnosis, Classification, Pathology, and Treatment

• Symptoms of heart failure (HF) are related to fluid overload, presenting as shortness of breath and edema, and can be due to problems with systolic or diastolic functions of the heart
• Ultrasound of the heart (echocardiography) is performed when HF is suspected, providing an estimate of left ventricular ejection fraction (LVEF)
• Two recommended classification systems for HF with reduced ejection fraction (HFrEF) are the American College of Cardiology/American Heart Association stages and the New York Heart Association classification
• Cardiac output depends on stroke volume and heart rate, influenced by preload, afterload, and contractility
• HF is characterized by the heart's inability to meet the body's demands, leading to myocyte loss, fibrosis, and compensatory mechanisms that can lead to cardiac remodeling
• The renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and vasopressin are activated in HF, leading to deficient natriuretic peptides
• RAAS activation causes vasoconstriction, sodium and water retention, and increased potassium excretion
• SNS activation leads to increased heart rate, contractility, and vasoconstriction
• Medications used to treat HF include RAAS inhibitors (ACE inhibitors, ARBs, aldosterone antagonists), beta blockers, SGLT2 inhibitors, neprilysin inhibitors, inotropic agents, and other diuretics and vasodilators
• SGLT2 inhibitors have shown a mortality benefit in HF treatment
• Neprilysin inhibitors increase the levels of natriuretic peptides and bradykinin, reducing blood volume, and are available in combination with valsartan as an alternative to ACE inhibitors
• In the Paradigm-HF trial, valsartan/sacubitril was found to reduce cardiovascular death or hospitalization from heart failure compared to enalapril

Heart Failure: Symptoms, Diagnosis, Classification, Pathology, and Treatment

• Symptoms of heart failure (HF) are related to fluid overload, presenting as shortness of breath and edema, and can be due to problems with systolic or diastolic functions of the heart
• Ultrasound of the heart (echocardiography) is performed when HF is suspected, providing an estimate of left ventricular ejection fraction (LVEF)
• Two recommended classification systems for HF with reduced ejection fraction (HFrEF) are the American College of Cardiology/American Heart Association stages and the New York Heart Association classification
• Cardiac output depends on stroke volume and heart rate, influenced by preload, afterload, and contractility
• HF is characterized by the heart's inability to meet the body's demands, leading to myocyte loss, fibrosis, and compensatory mechanisms that can lead to cardiac remodeling
• The renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and vasopressin are activated in HF, leading to deficient natriuretic peptides
• RAAS activation causes vasoconstriction, sodium and water retention, and increased potassium excretion
• SNS activation leads to increased heart rate, contractility, and vasoconstriction
• Medications used to treat HF include RAAS inhibitors (ACE inhibitors, ARBs, aldosterone antagonists), beta blockers, SGLT2 inhibitors, neprilysin inhibitors, inotropic agents, and other diuretics and vasodilators
• SGLT2 inhibitors have shown a mortality benefit in HF treatment
• Neprilysin inhibitors increase the levels of natriuretic peptides and bradykinin, reducing blood volume, and are available in combination with valsartan as an alternative to ACE inhibitors
• In the Paradigm-HF trial, valsartan/sacubitril was found to reduce cardiovascular death or hospitalization from heart failure compared to enalapril