Heart failure long-term drug treatment

Heart Attack Without Cardiac Arrest Angina Pectoris Heart Failure Long-Term Treatments Biofeedback Changing of Behavior Dietary Measures Donations of Blood Drugs Exercise Surgery Summary... 

Ideally, if symptomatic sinus node dysfunction occurs in the presence of drugs known to impair sinus node function, the first treatment is to discontinue the offending drug [29]. However, this is typically not feasible in patients with heart failure who are dependent on several medications to improve long-term outcomes, or may need antiarrhythmic drug therapy for symptomatic arrhythmias. Accordingly, the treatment usually becomes a question of whether to apply pacing to increase heart rate. This is further complicated by the appropriate pacemaker prescription once the decision to pace has been made. 

Treatment of atrial fibrillation is initiated to relieve patient symptoms and prevent the complications of thromboembolism and tachycardia-induced heart failure, the result of prolonged uncontrolled heart rates. The initial treatment objective is control of the ventricular response. This is usually achieved by use of a calcium channel-blocking drug alone or in combination with a 13-adrenergic blocker. Digoxin may be of value in the presence of heart failure. A second objective is a restoration and maintenance of normal sinus rhythm. Several studies show that rate control (maintenance of ventricular rate in the range of 60-80 bpm) has a better benefit-to-risk outcome than rhythm control (conversion to normal sinus rhythm) in the long-term health of patients with atrial fibrillation. If rhythm control is deemed desirable, sinus rhythm is usually restored by DC cardioversion in the USA in... 

Researchers John Baer, Karl Beyer (1914—1996), James Sprague (1916- ), and Frederick Novello formulate the drug chlorothiazide, the first of the thiazide diuretics. This groundbreaking discovery marked a new era in medicine as the first safe and effective long-term treatment for chronic hypertension and heart failure. 

Although the phosphodiesterase inhibitors are effective in the treatment of acute cardiac failure in various settings, overall mortality during long-term treatment of heart failure is increased, and these drugs should not be used for that purpose (8). 

The rationale underlying the treatment of chronic HTN concerns its association with atherosclerosis and the increased risk of stroke, heart failure, renal diseases, peripheral vascular disease, and coronary artery disease. Except in severe HTN, there is no rash to start drug Rx prior to lifestyle changes because the goals are long term. Factors in hypertension include decreases in vagal tone, increases in sympathetic tone, increased renin-angiotensin activity, and water retention. 

Tolerance can limit the long-term effectiveness of nitrates in the treatment of CHF. Blood levels of these drugs should be permitted to fall to negligible levels for at least 6-8 hours each day, which can be adjusted to the patient s symptoms. Patients with recurrent orthopnea or paroxysmal nocturnal dyspnea, for example, would likely benefit most by using nitrates at night. N-acetylcysteine (mucomyst) may diminish tolerance to the hemodynamic effects of nitrates in heart failure. Likewise, hydralazine may decrease nitrate tolerance by an antioxidant effect that attenuates superoxide formation, thereby increasing NO bioavailability. 

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