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Drugs for CCF

Drugs for CCF. Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs. It is classically accompanied by significant fluid retention. It is a leading cause of mortality and morbidity. Drugs for CCF.

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Drugs for CCF

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  1. Drugs for CCF • Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs. • It is classically accompanied by significant fluid retention. • It is a leading cause of mortality and morbidity.

  2. Drugs for CCF • The most common symptoms of CCF includes shortness of breath, edema and fatigue. • Causes of heart failure includes Coronary artery disease (CAD), Hypertension, Diabetes, Mitral valve disease and Chronic alcohol.

  3. Drugs for CCF

  4. Drugs for CCF • Vasodilators – ACE Inhibitors • Diuretics • Beta blockers • Digoxin • Other Cardiac Inotropes – Dobutamine, Milrinone

  5. Drugs for CCF Angiotensin Converting Enzyme (ACE) Inhibitors : • ACE inhibitors improve mortality, morbidity, exercise tolerance, left ventricular ejection fraction. • Captopril, Lisinopril, Enalapril, Ramipril, Quinapril.

  6. ACE Inhibitors for CCF

  7. ACE Inhibitors for CCF

  8. Drugs for CCF Angiotensin Converting Enzyme (ACE) Inhibitors : • Reduction in arterial resistance (afterload) • Reduction in venous tension (preload) • Reduction in aldosterone secretion • Inhibition of cardiac and vascular remodeling

  9. Drugs for CCF Angiotensin Converting Enzyme (ACE) Inhibitors : Adverse effects : • Dry irritating persistent cough • Hyperkalemia • Angioedema • Fetal toxicity

  10. Drugs for CCF Angiotensin Receptor AT-1 blockers (ARB) : Losartan, Irbesartan, Candesartan • Competitive antagonists of Angiotensin II (AT-1). • No inhibition of ACE or Cough.

  11. Drugs for CCF Vasodilators : • Isosorbidedinitrate and hydralazine also used specially in patients who cannot tolerate ACE inhibitors. • Amlodipine and prazosin are other vasodilators can be used in CCF.

  12. Nitrates in CCF

  13. Drugs for CCF Diuretics : These are useful in reducing the symptoms of volume overload by • decreasing the extra cellular volume • decreasing the venous return

  14. Drugs for CCF Diuretics : • Loop diuretics like furosemide and bumetanide are the most effective and commonly used. • Thiazides are effective in mild cases only.

  15. Drugs for CCF Diuretics :Adverse effects : • Loop diuretics and thiazides cause hypokalemia. • Potassium sparing diuretics help in reducing the hypokalemia due to these diuretics.

  16. Drugs for CCF Potassium Sparing Diuretics : Spironolactone : • Aldosterone inhibition minimize potassium loss, prevent sodium and water retention, endothelial dysfunction and myocardial fibrosis.

  17. Drugs for CCF Spironolactone : Aldosterone antagonist • Spironolactone can be added to loop diuretics to modestly enhance the diuresis; more importantly, improve survival.

  18. Drugs for CCF Beta blockers for congestive cardiac failure : • Acts primarily by inhibiting the sympathetic nervous system. • Increases beta receptor sensitivity (up regulation). • Anti-arrhythmic properties. • Anti-oxidant properties.

  19. Beta blockers in CCF

  20. Drugs for CCF Beta blockers for CCF : • Start at low dose and monitor for bradycardia • Carvedilol and Metoprolol are the most commonly used for CCF amongst beta blockers

  21. Drugs for CCF Cardiac glycosides : Digoxin : • Inhibition of Na/K ATPase pump increase intracellular sodium concentration – eventually increase cytosolic calcium. • It restores the vagal tone and abolishes the sympathetic over activity.

  22. Digoxin in CCF

  23. Drugs for CCF Cardiac glycosides : Digoxin : • Increase the refractoriness of AV node thus decrease ventricular response to atrial rate. • Digoxin is used as a first-line drug in patients with congestive heart failure who are in atrial fibrillation.

  24. Drugs for CCF Digoxin : Adverse effects / Precautions : • Nausea, vomiting, gynecomastia, visual disturbances and psychosis. • Ventricular bigeminy, AV block and bradycardia. • Amiodarone and verapamil can increase the plasma concentration of digoxin by inhibiting its excretion.

  25. Drugs for CCF • Digoxin toxicity treatment: • Toxicity can be treated with higher than normal doses of potassium. • Digoxin antibody (digibind) is used specifically to treat life-threatening digoxin overdose.

  26. Drugs for CCF Cardiac Inotropes : • Phosphodiesterase III Inhibitors Positive inotropic and vasodilator – INO-DILATOR ; Eg., Milrinone • Dobutamine is a beta-1 agonist which increase contractility and cardiac output.

  27. Drugs for CCF Conclusion : • ACE inhibitors are cornerstone in the treatment of CCF. • Beta blockers are used in selected patients (mild/moderate failure, low dose) • Diuretics and digoxin are other drugs useful in CCF in select patients.

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