Cardiac insufficiency

Most of the herbal drugs that are used medicinally are comprised in these five groups of indications. Relative few are employed in a limited number of other areas occasionally in skm remedies, liver remedies, coronary remedies, blood circulation remedies, and in other groups of medicines. Summarizing, it can be said that the possibilities of treatment with herbal drugs are limited for a number of reasons for a series of illnesses like severe cardiac insufficiency, tumours, infectious diseases, diabetes, etc., herbal drugs arc not adequate remedies, even though, in contravention of the law, such claims are made in many publications. In a series of further cases, they only find use in support of the actual medical treatment they are nevertheless of value. 

Most adverse effects of labetalol are mild and do not require discontinuation of therapy. Examples of the adverse reactions include fatigue, drowsiness, insomnia, weakness, hypotension, diarrhea, dyspnea, and skin rash. Adverse reactions of carvedilol include fatigue, hypotension, cardiac insufficiency, chest pain, bradycardia, dizziness, diarrhea, hypotension, and fatigue... 

Cardiotonic agents are sometimes called positive inotropic drags, i.e. substances that enhance the strength of muscle contractions, and in this case those that enhance the strength of myocardium contraction. Cardiotonic drugs are intended for treating cardiac insufficiency. 

Cardiac insufficiency is a very common disease. It can be defined as an inability of the heart to pump a sufficient amount of blood to supply oxygen and nutrients to organs and tissue, which leads to fatigue, shortness of breath, and edema. Cardiac insufficiency is most often caused by arterial hypertension and ischemic heart disease. It can be manifested in severe form, as a sharp decline in cardiac output with symptoms of disrupted blood flow, and in chronic form, which is manifest as heart pain. 

Optimal therapy for cardiac insufficiency frequently requires simultaneous use of two or more of the aforementioned groups of drugs. 

Digitoxin is used for chronic cardiac insufficiency, tachyarrhythmia form of atrial fibrillation, paroxysmal ciliary arrhythmia, and paroxysmal supraventricular tachycaria. Synonyms of this drag are cardigin, cordalin, crystodigin, purodigin, and others. 

Digoxin exhibits strong systolic action and slows heart rate. It is removed from the organism faster than digitoxin. It is used from chronic cardiac insufficiency in decompensated valvular disease of the heart, myocardium overload in arterial hypertension, tachycardia, ventricular fibrillation, and other analogous situations. Synonyms of this drug are cedoxin, lanacordin, lanoxin, and others. 

Strophanthin is used in severe cardiovascular insufficiency, in particular after myocardial infarction, for chronic cardiac insufficiency, cardiac decompensation, supraventricular tachycardia, and ventricular arrhythmia. Synonyms of this drug are combetin, strofopan, and others. 

Clinical use of amiodarone is limited because of its high toxicity, which consists of cardiac block, bradycardia, cardiac insufficiency, damaged thyroid gland function, neuropathology, and increased sensitivity to light, all of which significantly limit use of amiodarona, and it is only used in therapy for extremely serious tachyarrhythmias such as reoccurring ventricular fibrillation and hemodynamic unstable ventricular tachycardia, and only under supervision of a physician in a clinical situation. Synonyms of amiodarone are cordarone, rythmarone, and others. 

Over the past 10 years, coronary vasodilating agents have been reconunended as the primary compounds for treating cardiac insufficiency. 

Pentaerythritol tetranitrate is used for chronic cardiac insufficiency. It prevents angina pectoris attacks and eases their course. Synonyms of this drug are nitropentan, nitrinal, vaso-cor, vasolat, pentilan, erinit, and many others. 

Isosorbide dinitrate is also used in chronic cardiac insufficiency for preventing angina pectoris attacks. It is a long-lasting drug. Synonyms of this drug are isordil, metronitron, vas-cardin, and others. 

Nifedipine is used for preventing and relieving angina pectoris attacks, for hypertension, and as an ingredient in combination therapy for chronic cardiac insufficiency. Synonyms of this drug are adalat, corinfar, procardia, and nifecor. 

Dinretics are widely used in medicine for very diverse pathologies, primarily for relieving edema, treating hypertension, cardiac insufficiency, hypercalcinuria, glaucoma, and a few forms of epilepsy, liver cirrhosis, and nephrosis. 

Acetazolamide is a weak diuretic with limited use in edema associated with cardiac insufficiency, glaucoma, minor epileptic attacks, and altitude sickness. Synonyms of this drag are midamor, modamide, cetazol, diamox, dicarb, and others. 

Metolazone acts on the distal tubules, thus increasing excretion of water and sodium, potassium, and chloride ions. It is used for treating edema caused by cardiac insufficiency and adrenal irregularities, including nephrotic syndrome. Synonyms of this drug are diulo, matenix, and zaroxolyn. 

Indapamide is a derivative of benzolsulfonamide and its mechanism of action is analogous to that of thiazides. It is intended for lowering arterial blood pressure and as an adjuvant drug for treating edema caused by cardiac insufficiency. Synonyms of this drug are lozol and others. 

Bumetanide is used for relieving edema associated with cardiac insufficiency, for liver and kidney diseases including nephrotic syndrome, for ascites, and hypertension. Synonyms of this drug are bumex and others. 

Ethacrynic acid is a powerful diuretic prescribed for edema associated with cardiac insufficiency, renal edema that does not respond to other diuretics, and edema of the brain and lungs. Synonyms of this drug are uregit, edecrin, and others. 

Moreover, whether or not hypertension is caused by an elevated level of renin or other reasons, angiotensin-converting enzyme inhibitors lower both systolic and diastolic arterial pressure in hypertensive patients, and their effects are enhanced by diuretics. Angiotensin-converting drugs of this series (captopril, enalapril) are effective antihypertensive drugs used both independently and in combination with other drugs to treat all types of hypertension as well as to treat cardiac insufficiency. 

Renal, hepatic, or cardiac insufficiency Use with caution in renal, cardiac, or hepatic insufficiency because of potential toxicity. 

As a general guide, for younger adult patients with normal renal function, an initial total daily oral dose of 50 mg/kg or less may be used, given in divided doses every 3 hours, to maintain therapeutic blood levels. For older patients, especially those older than 50 years of age, or for patients with renal, hepatic, or cardiac insufficiency, lesser amounts or longer intervals may produce adequate blood levels and decrease the probability of occurrence of dose-related adverse reactions. Administer the total daily dose in divided doses at 3-, 4- or 6-hour intervals and adjust according to the patient s response. 

Bepridll History of serious ventricular arrhythmias uncompensated cardiac insufficiency congenital QT interval prolongation use with other drugs that prolong QT interval. 

Patients without history of cardiac failure (latent cardiac insufficiency) Continued depression of myocardium with -blockers can lead to cardiac failure. 

CIBIS II Investigators and Committee. The cardiac insufficiency bisoprolol study II (CIBIS-II) a randomised trial. Lancet 1999 353 9-13. 

Willenheimer R, van Veldhuisen DJ, Silke B, et al. Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation. Oct 18 2005 112(16) 2426-2435. 

A decreased responsiveness induced by disease is shown in Fig. 13. Cardiac insufficiency is associated with a decrease in max and an increase in C5o% for furosemide. 

Contraindications Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis in those not treated with neostigmine, narrow-angle glaucoma, obstructive disease of the GI tract, paralytic ileus, severe ulcerative colitis, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, toxic megacolon, unstable cardiovascular status in acute hemorrhage... 

Contraindications Sick sinus syndrome/second- or third-degree AV block (except in presence of pacemaker), severe hypotension (less than 90mmFIg, systolic), history of serious ventricular arrhythmias, uncompensated cardiac insufficiency, congenital QT interval prolongation, use with other drugs prolonging QT interval... 

Overdose may produce profound bradycardia, hypotension, bronchospasm, cardiac insufficiency, cardiogenic shock, and cardiac arrest. 

---