Which of the following is used in the treatment of CHF? (PNQ)
|D||None of the above|
New drugs in the management of CHF
1. Eplerenone (Aldosterone receptor blocker)
2. Nesiritide(Vasodilation) (BNP analogue)
3. Levosimendan used for the treatment of acute and decompensated CHF, exerts potent positive inotropic action and peripheral vasodilatory effects. (Ref. Hari-18th ed., Pg 1912)
4. Coenzyme Q is a universal antioxidant drug, improves diastolic volume and ejection fraction in CHF patients. (Ref. Hari-18th ed., Pg 1912)
5. Arjuna terminalis (AIIMS May 2012)
6. Hydralazine + isosorbide dinitrate (Ref. Hari-18th ed. pg 1908)
Extra Edge:Nesiritide: (Ref. Hari- 18th ed., Pg-2237)
1. The newest vasodilator, is a recombinant form of brain-type natriuretic peptide, which is an endogenous peptide secreted primarily from the LV in response to an increase in wall stress.
2. Nesiritide effectively lowers LV filling pressures and improves symptoms during the treatment of acute HF.
Positive Inotropic Drugs Used in Heart Failure
It is a drug that sensitizes the troponin system to calcium, also appears to inhibit phosphodiesterase and to cause some vasodilation in addition to its inotropic effects.
a. It increases contractility by inhibiting Na+, K+ ATPase (like cardiac glycosides) but in addition, facilitates sequestration of Ca2+ by the SR.
b. Although they have positive inotropic effects, most of their benefits appear to derive from vasodilation.
c. It is used for treatment of acute decompensated heart failure.
Icatibant is used in the treatment of acute attacks of hereditary angioedema (HAE) in adults (with C1-esterase-inhibitor
deficiency). Angioedema is a dangerous side effect of ACEI therapy.
1. Cardiac Resynchronization
a. Approximately one-third of patients with a depressed Ejection Fraction (less than 35%) and symptomatic HF (NYHA class III–IV) manifest a QRS duration >120 ms.
b. This ECG finding of abnormal inter- or intraventricular conduction is used to identify patients with dyssynchronous ventricular contraction.
c. The mechanical consequences of ventricular dyssynchrony include suboptimal ventricular filling, a reduction in LV contractility, prolonged duration (and therefore greater severity) of mitral regurgitation, and paradoxical septal wall motion.
d. Biventricular pacing, also termed cardiac resynchronization therapy (CRT), stimulates both ventricles nearly simultaneously, thereby improving the coordination of ventricular contraction and reducing the severity of mitral regurgitation. (Ref. Hari- 18th ed., Pg – 1911)
2. Implantable Cardiac Defibrillators (ICD) (Ref. Hari-18th ed., Pg -1912)
The prophylactic implantation of ICDs in patients with mild to moderate HF (NYHA class II–III) reduced the incidence of sudden cardiac death in patients with ischemic or nonischemic cardiomyopathy.