Introduction Heart failure (HF)

is one of the most common and fatal of the cardiovascular diseases, and its incidence is expected to increase as the population ages.

On your own!!

Cardiac Glycosides Cardiac glycosides

increase the force of myocardial contraction—Table 16.2 pg. 283

Traditional drugs of choice for HF

Extracted from foxglove plants (Digitalis purpura and Digitalis lanata)

Cardiac Glycosides Digitalis helps heart

contract more forcefully and beat slower

Narrow margin of safety

DP—digoxin (Lanoxin)---pg. 285Hold if HR < 60Monitor serum levels

Angiotensin Converting Enzyme (ACE Inhibitors)ACE inhibitors are becoming

first-line drugs for cardiac failure—Table 16.2 pg. 283

Lower peripheral resistance and reduce blood volume diminishes the after-load and increase cardiac output

Dilate veins returning blood to heart decreases preload and peripheral edema

DP—lisinopril (Prinivil, Zestoric) pg. 286

Vasodilators Vasodilators can help reduce

symptoms of heart failure by decreasing the oxygen demands on the heart—Table 16.2.

Minor role in drug therapy for HF.

Relax blood vessels and lower BP

Many side effects-reserved for clients who cannot tolerate ACE inhibitors

DP—isosorbide dinitrate (Isordil) pg. 289

Diuretics Diuretics are effective at

reducing fluid volume and relieving symptoms of heart failure—Table 16.2 pg. 283

Reduce blood volume, edema and congestion.

Workload on heart reduced and cardiac output increases.

Used in combination with other drugs to treat HF.

DP—furosemide (Lasix) pg. 287

Phosphodiesterase Inhibitors Phosphodiesterase inhibitors increase

the force of contraction and cause vasodilation—Table 16.2 pg. 283.

Used for short-term control of acute HF.

Block enzyme phosphodiesterase in cardiac muscle and smooth muscle

Very toxicReserved for clients not responding to

ACE inhibitors or cardiac glycosidesUsed generally 2-3 days

DP—milrinone (Primacar) pg. 288

Beta-Adrenergic Blockers Beta-adrenergic

blockers play a minor role in the treatment of HF

Reduce cardiac worklooad by decreasing afterload.

Usually used in combination with other drugs

DP—carvedilol (Coreg) pg. 289