Heart failure

• Heart Failure (HF)


  Complex, progressive disorder where the heart is unable to pump sufficient blood to meet the needs of the body

  
• Symptoms of Heart Failure

  • Dyspnea (shortness of breath)
  • Fatigue
  • Fluid retention

  
• Impaired ability of the heart


  Inadequate filling with and/or ejection of blood

  
• Underlying causes of HF

  • Arteriosclerotic heart disease
  • Myocardial infarction
  • Hypertensive heart disease
  • Valvular heart disease
  • Congenital heart disease

  
• Chronic activation of the sympathetic nervous system and the renin–angiotensin–aldosterone system

  • Remodeling of Cardiac Tissue
  • Loss of Myocytes
  • Hypertrophy
  • Fibrosis

  
• If left untreated, leads to death
• Goals of Pharmacologic Intervention in HF

  • Alleviate Symptoms
  • Slow Disease Progression
  • Improve Survival
• Seven Classes of Drugs for HF Treatment

  • Angiotensin-converting Enzyme Inhibitors
  • Angiotensin-receptor Blockers
  • Aldosterone antagonists
  • β-blockers
  • Diuretics
  • Direct Vaso- and Venodilators
  • Inotropic agents

  
• Depending on the severity of HF individual patient factors, one or more of these classes of drugs are administered
• Pharmacologic Intervention Provides


  • Reduced Myocardial Work Load
  • Decreased Extracellular Fluid Volume
  • Improved Cardiac Contractility
  • A Reduced rate of cardiac remodeling

  
• Therapeutic Strategies in HF

  • Fluid limitations (less than 1.5 to 2 L daily)
  • Low dietary intake of sodium (less than 2000 mg/d)
  • Treatment of comorbid conditions
  • Use of diuretics
  • Avoid drugs that may precipitate or exacerbate HF
  • Inhibitors of the renin–angiotensin–aldosterone system
  • Inhibitors of the sympathetic nervous system
  • Inotropic agents are reserved for acute HF