Info CHF Drug Therapy

• Drug Therapy for CHF:

  • With respect to drug therapy, individuals with CHD are likely to be on polypharmacology
  • Some of these drugs you have met previously when you looked at ACS
  • Whilst in ACS drugs may have been given to reduce the risk of ischaemia, here they may be given to “off-load” the work of the heart, thereby optimising cardiac output
• Pharmacology:

  • switching off/dampening down some of the adverse neuroendocrine and myocardial inflammatory responses to heart failure that act as long term drivers of structural maladaptation (which underpins the establishment and progression of coronary heart failure)
  • the future is to use target anti-inflammatories (in development)
  • managing heart failure - to enhance cardiac function and reduce pts symptoms and disabilities
• Pharmacological Management:

  • aim is to decrease cardiac workload:
  • decrease in pre-load (reduced blood volume / venous return)
  • decrease in after-load -> decrease in total peripheral resistance
  • decrease in contractility and heart rate
• Dampening drivers of maladaptive remodelling:

  
• CHF is a progressive condition:

  • to limit and control a decline in cardiac function, drugs and doses need to be regularly reviewed and altered
  • drug compliance is essential
  • life style modification is of paramount importance
  • to cope with an escalating risk of arrhythmias, pacemaker devices, ICD, CRT may be required
  • to cope with a declining contractile organ - LVADs may be required to support function
  • ultimately a cardiac transplant may be deemed necessary