HEART FAILURE-DRUGS

SUMMARY

1. ACEI: first-line therapy, improve pressures, prevent remodelling and decrease HR amongst others.

2. ARB: given in place of ACEI, equally effective.

3. Beta blockers: decrease sympathetic stimulation. Mortality is clearly improved by carvedilol (65%), metoprolol & bisoprolol (35%). Initiate at any stage of HF once adequate diuresis has been achieved.

4. Diuretics: used in stage C HF. Good for volume control. Though they do not have a mortality benefit. Note that loop &thiazide diuretics can act synergistically but cause profound hypokalemia.

5. Aldosterone antagonists (spironolactone, eplerenone): reduce morbidity and prolong survival in NYHA II-IV and with reduced EF < 35% These drugs competitively inhibit aldosterone (K+ sparing).

6. Digoxin: can decrease hospitalisation in low-output HF but has no mortality benefit. Appears to reset baroreceptors & dampen renin-aldosterone response. Also used to control ventricular rate in AF.

7. Nitrates: good venodilator &moderately arterial dilator. Give 6 hours between application to prevent tolerance.

8. Hydralazine: decreases preload. Used synergistically with nitrates.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].