Treatment of Congestive Heart Failure

Agents used in the treatment of congestive heart failure, Antiatherosclerotic agents. 

Nitroglycerin remains the dmg of choice for treatment of angina pectoris. It has also been found useful for the treatment of congestive heart failure, myocardial infarction, peripheral vascular disease, such as Raynaud s disease, and mitral insufficiency, although the benefits of nitroglycerin in mitral insufficiency have been questioned. 

AGENTS USED IN THE TREATMENT OF CONGESTIVE HEART FAILURE... 

The PDE3 inhibitor, cilostazol, has been used as an antithrombotic agent and is currently being used in patients being treated for intermittent claudication. Cilostazol is also used for the prevention of restenosis after treatments such as angioplasty. Another PDE3 selective inhibitor, milrinone, has been used in the treatment of congestive heart failure. Milrinone also has been shown to increase the conductance of the CFTR transporter in vitro. 

The outcome of this is to couple ATP hydrolysis with the vectorial transport of Na+ and K+ across the plasma membrane. The inhibition of the (Na+-K+)-ATPase by cardiac glycosides such as digitalis (an extract of foxglove leaves), which blocks the dephosphorylation of the E2-P form of the enzyme, is the basis for a number of steroid drags which are commonly prescribed for the treatment of congestive heart failure. 

Pharmaceutical preparations containing imidazolylphenylpyridazinones have been claimed as medicaments for the treatment of congestive heart failure [48,49]. Moreover, it should be mentioned that deaza-analogues, namely, pyrrol-1-ylphenyldihydropyridazinones, have also been claimed as cardiotonics [50,51]. 

Cardiac glycosides are drags used in the treatment of congestive heart failure or cardiac arrhythmia, by inhibiting the Na+/K+ pump. This inhibition increases the amount of Ca + ions available for contraction and improves cardiac output and reduces distention of the heart. Cardiac glycosides are extracted from plant material. 

Unlabeled uses Hydralazine in doses up to 800 mg 3 times/day has been effective in reducing afterload in the treatment of congestive heart failure (CHF), severe aortic insufficiency, and after valve replacement. 

Auricchio A, Klein H. Multiple chambered pacing for treatment of congestive heart failure. Pacing Clin. Electrophysiol. 1995 18 750-1. 

Naughton MT, Liu PP, Bernard DC, et al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med. Jan 1995 151(l) 92-97. 

Blockers are used as therapeutics in the treatment of hypertension, myocardial ischaemia (angina pectoris), tachyarrhythmias, and in the secondary prevention following myocardial infarction. More recently the cautious use of /3-blockers has been found to be of potential benefit in the treatment of congestive heart failure (NYHA stages II and III). 

Data are beginning to emerge indicating that ATi-blockers may be useful in the treatment of congestive heart failure, in particular of the patients who do not tolerate ACE-inhibitors (mostly because of cough). 

Triamterene can be used in the treatment of congestive heart failure, cirrhosis, and the edema caused by secondary hyperaldosteronism. It is frequently used in combination with other diuretics except spironolactone. Amiloride, but not triamterene, possesses antihypertensive effects that can add to those of the thiazides. 

Enalapril maleate is an orally active angiotensin converting enzyme (ACE) inhibitor, it lowers peripheral vascular resistance without causing an increase in heart rate. The maleate salt (enalapril) allows better absorption after oral administration. It is an ideal drug for hypertensive patients who are intolerant to beta-blocker therapy. It also shows promise in the treatment of congestive heart failure. Following oral adminishation, enalapril is rapidly absorbed and hydrolysed to... 

Dopamine itself has long been used as an inotropic agent in acute treatment of congestive heart failure. Both that compound and a number of its analogues have a positive action on contractility as a consequence of their adrenergic agonist activity. 

Crude leaf preparations of Digitalis have been in medical use since 1785. Pure cardiac glycosides are now available. These preparations in injectable tinctures or powdered leaf tablets are used extensively for the treatment of congestive heart failure. They increase the force of the heart muscle and the power of systolic contraction, apparently by inhibiting the active transport of K and Na ions through cell membranes. 

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