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Drugs for CCF

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

Angiotensin Converting Enzyme (ACE) Inhibitors :

  • ACE inhibitors improve mortality, morbidity, exercise tolerance, left ventricular ejection fraction.
  • Captopril, Lisinopril, Enalapril, Ramipril, Quinapril.
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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
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Drugs for CCF

Angiotensin Converting Enzyme (ACE) Inhibitors :

Adverse effects :

  • Dry irritating persistent cough
  • Hyperkalemia
  • Angioedema
  • Fetal toxicity
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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.
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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.
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Drugs for CCF

Diuretics :

These are useful in reducing the symptoms of volume overload by

  • decreasing the extra cellular volume
  • decreasing the venous return
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Drugs for CCF

Diuretics :

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

Diuretics :Adverse effects :

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

Potassium Sparing Diuretics : Spironolactone :

  • Aldosterone inhibition minimize potassium loss, prevent sodium and water retention, endothelial dysfunction and myocardial fibrosis.
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Drugs for CCF

Spironolactone : Aldosterone antagonist

  • Spironolactone can be added to loop diuretics to modestly enhance the diuresis; more importantly, improve survival.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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.