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Medicines For Heart Failure

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Heart Failure | Pharmacology (ACE, ARBs, Beta Blockers, Digoxin, Diuretics)

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Isosorbide Dinitrate And Hydralazine

Action:

  • Dilate blood vessels to improve the amount of blood the heart pumps to the body.
  • Combination may be particularly beneficial in African American patients.
  • Effective for heart failure even in patients without high blood pressure.

Side effects:

  • Headache. Common after this combination is started can take Tylenol® to control. Should become less intense with time.
  • Low blood pressure. Check your blood pressure at home.
  • Medications for erectile dysfunction interact with isosorbide dinitrate, and should be avoided.
  • Dizziness. Take separately from other medications that cause dizziness.
  • Get up more slowly from lying or seated position.
  • Nausea. May take with small frequent meals.

Heart Failure With Preserved Ejection Fraction

Compared to those with a reduced ejection fraction, patients with heart failure with preserved ejection fraction are older, more likely to be female and to have hypertension, atrial fibrillation, diabetes or obesity. The mechanism probably relates to a combination of pathophysiological processes including increased myocardial stiffness, abnormal myocardial relaxation and increased arterial stiffness.

No drug has been shown to improve survival,35 however recent data suggest that in a subset of patients with heart failure and preserved ejection fraction, aldosterone antagonists may improve clinical outcomes.36 Sacubitril with valsartan was found to be beneficial in a phase II study.37 The combination is therefore currently under evaluation for heart failure with preserved ejection fraction.

Diuretics should be used judiciously and over-diuresis avoided. Treatment should focus on aggressive control of concurrent conditions particularly hypertension. Atrial fibrillation should be managed according to guidelines, using a rate control strategy and anticoagulation initially, with a trial of rhythm control for persistent symptoms. Myocardial ischaemia, obesity and anaemia should be addressed. Exercise training can improve quality of life.

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Drug Treatment For Heart Failure

, MD, SM, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary

Heart failure Heart Failure Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up of blood in the veins and lungs, and/or… read more is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up of blood in the veins and lungs, and/or other changes that may further weaken or stiffen the heart. Drug treatment of heart failure involves

  • Drugs to help relieve symptoms: Diuretics, vasodilators, or digoxin

  • Drugs to help improve survival: Angiotensin-converting enzyme inhibitors, beta-blockers, aldosterone antagonists, angiotensin II receptor blockers , angiotensin receptor/neprilysin inhibitors , sodium-glucose co-transporter 2 inhibitors, or sinus node inhibitors

, HFrEF), all drug classes helpful. In diastolic heart failure of blood in the veins and lungs, and/or… read more , HFpEF), only ACE inhibitors, ARBs, aldosterone antagonists, and beta-blockers are typically used. In heart failure with mid-range ejection fraction, ARNIs may be helpful.

It is important for people to take their drugs regularly and be sure not to let the prescription run out.

Classes Of Medications For Heart Failure

FDA Approves New Heart Failure Medication

Doctors use a variety of medicines to manage heart failure. This includes drugs that reduce the hearts workload, help the heart pump more blood, and reduce fluid buildup in the body. Your doctor may also recommend drugs to prevent blood clots and reduce cholesterol. Most people with heart failure take more than one medication.

Classes of heart failure drugs include:

To help doctors choose the best treatment, they follow expert guidelines and recommendations. Your doctor will consider your symptoms, test results, and stage of heart failure. After starting treatment, your doctor will monitor your response. It may be necessary to adjust your dose, change drugs, or add another drug for optimal treatment.

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Medications For Heart Failure

Certain medications can help treat heart failure and its underlying cause:

  • Aldosterone blockers block the effects of the hormone aldosterone, encouraging the body to release sodium and water. They also help prevent scarring in the heart.
  • Angiotensin receptor-neprilysin inhibitor : Treatment with sacubitril-valsartan reduces excess fluid in the body and relaxes blood vessels. This makes it easier for your heart to pump blood. Alternatives to ARNIs include angiotensin-converting enzyme inhibitors andangiotensin receptor blockers .
  • Beta blockers make the heart beat more slowly and with less force. They also help keep heart rhythm regular.
  • Sodium-glucose transport protein 2 inhibitors are diabetes drugs that have recently been found to be very beneficial in heart failure. They help remove glucose via the kidneys into the urine.

Other medications can relieve the heart failure symptoms:

  • Diuretics reduce the amount of fluid in the body.
  • Vasodilators dilate the blood vessels and reduce the hearts workload.
  • Digoxin helps the heart beat stronger with a more regular rhythm.
  • Anti-arrhythmics control arrhythmia and maintain normal heart rhythm.

What Conditions Are Medicines Used For

  • angina – pain or discomfort in the chest, or shortness of breath
  • heart attack – when there is a blockage in a coronary artery
  • high blood pressure – also called hypertension
  • heart failure – when the main pumping action of the heart is not working as well as it should be
  • arrhythmia – a heart rhythm that may be too slow, too fast or irregular. See Chest Heart & Stroke Scotland for more on arrhythmias.
  • heart valve disease – when one or more of the four valves in the heart is diseased or damaged. See Chest Heart & Stroke Scotland for more on heart valve problems.
  • high blood cholesterol level – also called hypercholesterolaemia, which, if left untreated, increases the risk of having a heart condition.

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Imaging And Other Tests

Other tests provide pictures of the heart and surrounding structures or show how well the heart is working:

  • Electrocardiogram : An electrocardiogram test uses small sensors to measure heart rate , rhythm and electrical impulses.
  • Chest X-ray: A chest X-ray is a picture of your lungs, heart and surrounding structures. It can show whether there is fluid in your lungs from heart failure, or if your heart muscle is enlarged.
  • Echocardiogram : Echocardiography uses sound waves to create images of your heart. It can show how thick the heart muscle has become, as well as measure ejection fraction.
  • MRI: MRI is an advanced imaging test that takes pictures of the heart and surrounding structures. It helps determine your heart function and size and whether there are any changes in the heart muscle. A cardiac MRI may help your doctors identify causes of heart failure.

Drug Therapy For Heart Failure With Reduced Ejection Fraction

Medication of Heart Failure â Cardiology | Lecturio

The goal of management of heart failure with reduced ejection fraction is to control symptoms, prevent progression of left ventricular dysfunction, decrease hospitalisation and improve survival. Drugs which block neurohormonal activation are the cornerstone of therapy. They include ACE inhibitors and beta blockers, as well as aldosterone antagonists . A new combination of sacubitril and valsartan enhances neurohormonal modulation by increasing beneficial natriuretic peptides.

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Warfarin To Prevent Blood Clots

This drug is a stronger anti-clotting agent than aspirin and clopidogrel. It works as an anticoagulant or blood thinner. Warfarin was widely used in the past to prevent the formation of clots if you have atrial fibrillation, an artificial heart valve or if you have blood clots in your legs.

Dr. Cho says now Warfarin is no longer the first line medication choice for afib or a blood clot in the leg or lungs. Its primarily used for heart valve disease. And because it interacts with other medications and diet, it requires close monitoring by a physician.

The first line drug for afib is novel oral anticoagulants, she says.

Ace Inhibitors And Arbs

ACE inhibitors and ARBs work by opening blood vessels and lowering blood pressure. These medicines can:

  • Reduce the work your heart has to do
  • Help your heart muscle pump better
  • Keep your heart failure from getting worse

Common side effects of these drugs include:

  • Dry cough
  • Headache
  • Diarrhea

When you take these medicines, you will need to have blood tests to check how well your kidneys are working and to measure your potassium levels.

Most of the time, your provider will prescribe either an ACE inhibitor or an ARB.

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The Bulging Medicine Cabinet

A potential problem with the success of drugs for heart-failure treatment is that it means the number of drugs that people are taking has increased. When new drugs are developed, they are typically not compared in head-to-head studies with old drugs. As a result, old drugs don’t get replaced instead, the new drugs are often added to existing heart-failure treatment. This can add up to a lot of pills to swallow. The greater the number of pills, of course, the harder it becomes to stick to a drug regimen.

“This can be a real problem,” says Bennett. “A lot of these patients are elderly, they don’t feel well, and they may not be able to see well. Following a complicated drug regimen can be hard for them.”

“We’re facing an era when patients are going to be taking multiple drugs and perhaps even have devices too,” Cohn tells WebMD. “We’re making therapy very complicated.”

But while Pitt agrees that additional medicines may complicate heart-failure treatment, he feels that complexity is the cost of progress. “If I can show you that I’m adding a benefit to with another drug, I’m not going to apologize for that,” he says. He also observes that drug cocktails have become common in the treatment of other diseases, such as cancer.

Water Pills Or Diuretics

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Diuretics help your body get rid of extra fluid. Some types of diuretics may also help in other ways. These drugs are often called “water pills.” There are many brands of diuretics. Some are taken once a day. Others are taken 2 times a day. The most common types are:

  • Thiazides. Chlorothiazide , chlorthalidone , indapamide , hydrochlorothiazide , and metolazone
  • Loop diuretics. Bumetanide , furosemide , and torasemide
  • Potassium-sparing agents. Amiloride , spironolactone , and triamterene

When you take these medicines, you will need regular blood tests to check how well your kidneys are working and measure your potassium levels.

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Left Ventricular Assist Devices

Left ventricular assist devices are mechanical pumps that can help if your left ventricle isn’t working properly and medication alone isn’t helping.

They may be used as a permanent treatment if you can’t have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

Read more about LVADs on the British Heart Foundation website.

How Are Medicines Taken

  • under your tongue – you put a tablet under your tongue and allow it to dissolve, or you spray the medicine directly under your tongue
  • into a veing – injected directly into a vein, or given in a diluted form through an intravenous drip
  • into a muscle – given by an injection into a muscle, like the buttock or thigh
  • under the skin – given by an injection just under the skin
  • self-adhesive patch – you put a patch containing the medicine on your skin, and the medicine is absorbed gradually

Most medicines need to be taken regularly, as prescribed by your doctor. Some medicines need to be taken only when you get a particular symptom, like angina.

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Types Of Heart Medications

If you’ve had a heart attack, you will most likely be prescribed medication that you will take for the rest of your life.

There are many types and combinations of drugs used to treat coronary artery disease , and your doctor or other health care provider will decide the best treatment combination for your situation.

The following gives you a quick look at many typical cardiac medications. Your prescription may have a different name from the ones listed on this chart. Brand names commonly available in the U.S. are shown in parentheses after the generic name for each drug.

*Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, the AHA is not recommending or endorsing any specific products. If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information. It’s important to discuss all of the drugs you take with your provider and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting the prescribing doctor.

Commonly prescribed include:

What the Medication Does

Reason for Medication

The Future Of Drug Treatment

Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2

But the significance of these failures is the subject of some debate among heart-failure experts.

“I think our vision is very short,” says Pitt. “A lot of people … were saying that we had exhausted the potential of neurohormonal blockade and that ACE inhibitors and beta-blockers were as good as we could get. That wasn’t true.”

Pitt sees potential in other drugs used to affect hormonal levels, including statins, which are used to treat high cholesterol. Some of the hormonal drugs that have had disappointing results in trials are also being studied further.

Other drug studies are focusing on the possibilities of more effectively treating diastolic dysfunction, which is often overshadowed by the more common systolic dysfunction. Researchers and doctors have only recently begun to truly understand diastolic dysfunction — which occurs when the heart loses its ability to relax and fill with blood.

“There are a number of approaches that are in the early stages of testing and we’re just going to have to wait and see,” Pitt says. “But I suspect that over the next few years, we’re going to find more and more effective drugs.”

And despite the setbacks, there is still great reason to be optimistic about the effectiveness of drugs in heart-failure treatment.

Originally published May 2003.

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Types Of Heart Failure

The main types of heart failure are named for where they occur in the heart:

  • Left-sided heart failure
  • Biventricular heart failure

Clinicians also may classify heart failure as:

  • Acute: You have active symptoms of heart failure, with either a new diagnosis or with long-term heart failure.
  • Chronic: You have a history of heart failure, but your condition is relatively stable with no symptoms or with manageable symptoms.

This Article Has A Correction Please See:

  • Sophie Heleen Bots,
  • N Charlotte Onland-Moret,
  • Pim van der Harst,
  • Maarten J M Cramer,
  • Folkert W Asselbergs,,,
  • G Aernout Somsen,
  • Hester M den Ruijter
  • 1Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  • 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  • 3Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
  • 4Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  • 5Institute of Cardiovascular Science, Faculty of Popular Health Sciences, University College London, London, UK
  • 6Health Data Research UK and Institute of Health Informatics, University College London, London, UK
  • Correspondence to Prof. dr. ir. Hester M den Ruijter, Utrecht University, Utrecht 3508 TC, The Netherlands H.M.denRuijter-2umcutrecht.nl
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    Selection Of Drugs For Heart Failure

    Choice of drug depends on the type of heart failure along with individual patient characteristics. The most common classification of heart failure currently in use stratifies patients into

    In heart failure with mid-range ejection fraction , there may be a specific benefit from ARNIs, although this possibility requires confirmation.

    , digoxin is not effective and may be harmful. In addition, vasodilator therapy may also be poorly tolerated and has not shown benefit in these patients.

    All patients should be given clear and explicit information about their drugs, including

    • The importance of timely prescription renewal

    • The importance of adherence to therapy

    • How to recognize adverse effects

    • When to contact their physician

    Medicines For Heart Failure

    Drugs That Worsen Heart Failure Common in Hospitalized HF

    Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines.

    Some of the main medicines for heart failure include:

    • ACE inhibitors
    • hydralazine with nitrate
    • digoxin

    You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects.

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