MEDICAL MANAGEMENT OF HEART FAILURE

MEDICAL MANAGEMENT OF HEART FAILURE

Lifestyle management and medical management are the first line treatment for any heart failure situations. Lifestyle modifications include restricting activities, fluid restriction ,regular graded excercises ,salt restriction and prevention of infections. Medicines used falls into 5 categories.

  1. DIURETICS
  2. BETA BLOCKERS
  3. ACE INHIBITORS/ARBs
  4. DIGOXIN
  5. IONOTROPES

Torsa DIURETICS Diuretics removes the excess water collected in the body in heart failure by acting in the kidneys. Intravenous usage of these are lifesaving in pulmonary edema of sudden left heart failure. In more chronic situations it reduces, lung congestion,pedal edema and ascitis.The common diuretics used are Frusemide , Torsamide and Spironolactone. The main side effects of diuretics are loss of electrolytes like sodium,potassium and magnesium.

ACE INHIBITORS/ARBs

ACE inhibitors are angiotensin coverting enzyme inhibitors and  ARBs are Angiotensin receptor blockers, both acting in the same humoral pathway.

The commonly used ACE inhibitors are Ramipril, Captopril, Listnopril and commonly used commonly used ARBs are Losatran and Valsatran.

A nagging dry cough, renal impairment,Hypotentio,etc are the common side effects.

BETA- BLOCKERS.

Cardiac and vascular actions of certain hormones like Adrenaline,Nor-adrenaline,Dopamine are mediated through certain receptors ,which are named as alpha,Beta,etc .

In heart failure these hormones are in excess as a compensatory phenomena, but infact actually affect the heart adversely like increasing the heart rate,etc.

So blocking these receptors decrease the symptoms of heartfailure and increase the life expectancy.

Commonly used beta blockers are Metoprolol,Carvidilol and Bisaprolol.

The side effects of betablockers are bronchospasm leading to wheezeor cough, hypotention,etc

DIGOXIN

This is one of the oldest remedy for heart failure obtained from plants and used in traditional medicines.

It enhances the cardiac contraction and thus help in heart failure by improving its pumping capacity.

The side effects are nausea,vomiting and rythm abnormalities.

IONOTROPES

These are receptor enhancers which enhance the contraction. They are specially used in acute heart failure situations. They act on alpha receptors, beta receptors. Commonly used ones are Dopamine,Dobutamine, Adrenaline, Nor-adrenaline, Milrinine,etc