Goal for Heart Failure treatment is to increase the pump action of the heart while decreasing the workload:
Medications with positive inotropic effect that will INCREASE contractility of the heart:
- Digoxin
- Watch out for signs/symptoms of toxicity
- Be aware of many drug interactions
- Not commonly used
- Beta adrenergic agonists
- IV dobutamine
- Used as short term treatment of acute flare ups
- PDE Inhibitors (phoshodiestrase inhibitors)
- Also have vasodilation effect
- milrinone
- Given IV
- Will increase susceptibility of calcium into heart cells to increase pumping action.
Drugs that decrease afterload, or cardiac output by dilating the arteries and relaxing the arterioles:
- Angiotensin-Converting Enzyme Inhibitors (ACEIs)
- ACEIs are the first line drug of choice for treatment
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Angiotensin-Receptor Blockers (ARBs)
- Valsartan (Diovan)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Both ACEIs and ARBs will decrease the blood flow to the kidneys by suppressing the renin-angiotensin system
Drugs that decrease the preload by increasing the ventricular muscle stretch and contraction:
-
Diuretics
- Increase elimination of sodium and water by decreasing blood volume. They will decrease preload and systemic and pulmonary congestion
- Loop Diuretics
- Prevent sodium, chloride and water reabsorption at the loop of Henle in the kidneys
- Patient may also be on a potassium for replacement
- ALWAYS MONITOR POTASSIM LEVELS
- Furosemide (Lasix)
- Torsemide (Demadex)
- Bumetanide (Bumex)
- Postassium Sparring Diuretics
- These diuretics will hold on the potassium
- Still monitor Potassium, due to build up
- Spironlactone (Aldactone)
-
Beta Blockers
- Can have a negative inotropic effect by causing too low of blood pressure, orthostatic hypotension, and bradycardia
- Metoprolol (Toprol, Lopressor, Toprol XL)
- Atenolol (Tenormin)
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