Drugs for Congestive Heart Failure

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Drugs for Congestive Heart Failure
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BACKGROUND

• DEFINITION
• The inability of heart to meet the needs of
  peripheral systems.
• PATHOGENY
• myocardium contraction heart load
• SYMPTOMS
• weakness, fatigue and dyspnea, cyanosis, edema
  .

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Change of myocardial structure in CHF

• Apoptosis
• Extracellular matrix(ECM)
• fibrosis
• Myocardial hypertrophy and remodeling.

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Change of myocardial function in CHF

• Systolic dysfunction
• actin-troponin-tropomyosin system
• ATP
• Ca-excitation-contraction-coupling
• Diastolic dysfunction
• compliance

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Change of neural-endocrine system in CHF

• sympathetic nerve system activation
• renin-angiotensin-aldosterone system activation
• Arginine-Vasopressin
• Endothelin
• Tumor necrosis factor- a
• Atrial natriuretic peptide
• EDRF-NO
• Prostaglandins

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Classification of Drugs for CHF

• Cardiac glycosides
• ACEI
• Diuretics
• Others
• ß-R blockers
• CCB
• PDEI(phosphodiestrase inhibitor)
• Vasodilators

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Cardiac Glycosides

• Positive inotropic effect
• K-Na-ATPase Na Ca Ca
• Effects on neural-hormone
• To inhibit sympathetic nerve activity
• To enhance vagus nerve activity
• Electrophysiologic effects
• Effects on ECG
• Effects on Kidney

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Cardiac Glycosides

• P.K
• Absorption
• Distribution
• Metabolism
• Excretion
• Influencing factors

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Cardiac Glycosides

• Clinic uses
• CHF
• Arrhythmia Atrial fibrillation, Atrial flutter
• ADR
• Extracardiac
• Cardiac Supra -/-Ventricular arrhythmia , Atrial
  Ventricular Block , ventricular premature beat
• Therapy K, phenytoin sodium, lidocaine. Antibody
  of it.

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Cardiac Glycosides

• Interactions
• Antiarrhythmia
• Agents
• Digitoxin, Cediland, Strophanthin K
• PDEI (milrinone, amrinone, vesnarinone)
• ATP AC cAMP PDEI 5AMP

Ca influx
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RAS BLOCKERS

• ACEI (Captopril, enalapril)
• Mechanism
• a. Ang?
• ( )
• Hypertrophy proliferation
• of myocardium VSMC
• b. Afterload
• Antagonist of AT1 (Losartan)

• BK

( - )
NO
( )
diastolic dysfunction
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OTHERS

• ß-R blockers
• ß-R sensitivity
• RAS
• DIURETICS
• CCB proliferation LOAD
• Vasodilatiors

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REVIEW QUESTIONS

• The mechanisms of cardiac glycosides.
• The ADR of them.
• The classification of drugs for CHF.