Condition in which heart is unable to pump sufficient amounts of

What
is Congestive Heart Failure (CHF)?
blood to meet the metabolic demands of the body.
(emedicine.medscape.com/article/163062)

Due to any structural or functional cardiac disorder that impairs the

ability of the ventricle to fill with or eject blood.
CO decreased
Heart failure occurred when the heart failed to provide enough
oxygen needed by the body.

Remodelling of Heart failure

Drugs for CCF

Diuretics,
inhibitors

ACE

Reduce the number

of sacks on the
wagon

Like the carrot

placed in front

Inotrops

blockers

Limit the speed, thus

saving energy

Increase the
efficiencyVasodilators

Approach to the Patient with Heart Failure(1)

Assessment of LV function
(echocardiogram)
EF <
40%
Assessment
of
volume
status

Signs and
symptoms of fluid
retention
Diuretic
(titrate to euvolemic
state)

No signs and
symptoms of
fluid retention
ACE Inhibitor
-blocker

Digoxin

ACE Inhibitors in heart failure

ACE(angiotensin converting enzyme) inhibitors
inhibit theactivity of the enzyme ACE
thatdecreases the production of angiotensin II.
Captopril, enalapril, ramipril, lisinopril

Act by
Reduction of after load (prevent constriction of blood
vessel)
Reduction of preload (blocked secretion of aldosterone)
Prolong cardiac and vascular remodeling

ACE inhibitors are the most preferred drugs for

treatment of congestive heart failure
Side effect: dry cough, hyperkalemia

Angiotensinog
en
Renin

Angiotensin
I
Angiotensin Converting Enzyme
(ACE)

Synthesis
Blocker

ACE
inhibitor

Angiotensin II
Angiotensi
n Receptor
Blocker
AT2
Angiotensin III

AT1

Receptor
Blocker

Dosage of ACE Inhibitor(2)

Captopril(dose adjustment required in renal impairment)
CHF (with diuretic and digitalis): 6.25-12.5 mg PO TID

Enalapril(dose adjustment required in renal impairment)

CHF: 2.5 mg PO once daily or q12hr

Fosinopril
CHF: 10 mg PO once daily

Lisinopril(dose adjustment required in renal impairment)

CHF: 2.5-5 mg PO once daily

Quinapril(dose adjustment required in renal impairment)

CHF: 5 mg PO BID

Ramipril(dose adjustment required in renal impairment)

CHF after MI: 2.5 mg PO BID

(emedicine.medscape.com/article/2172124)

Angiotensin receptor blockers in heart

failure
Angiotensin II receptor blockers (ARBs) are
medications that block the action of angiotensin II by
preventing angiotensin II from binding to angiotensin
II receptors on the muscles surrounding blood vessels
Losartan , candesartan, valsartan, telmisartan
Block AT1 receptor on the heart, peripheral
vasculature and kidney
As effective as ACE inhibitors
Used mainly in patients who cannot tolerate ACE
inhibitors because of cough, angioedema,
neutropenia

Dosage of ARB
Valsartan
40 mg BID

Candesartan
4 mg QD

Beta Blockers
Metoprolol, bisoprolol, carvedilol
Acts primarily by inhibiting the sympathetic
nervous system.
Beta-blockers can slow the progression of systolic
forms of heart failure.
Beta-blockers may be used to treat left
ventricular systolic dysfunction in people who are
stable and have no symptoms or only mild to
moderate heart failure symptoms.
Beta-blockers may be used together with other
medicines that are usually used to treat heart
failure, such as angiotensin-converting enzyme
(ACE) inhibitors or diuretics.

 Beta-blockers help treat diastolic heart

failure, because they slow the heart rate
and allow more time for your heart to fill
with blood.
This allows the left ventricle to fill more
completely and increases the volume of
blood that the heart pumps with each
heartbeat (ejection fraction).
Then, your heart can pump more blood
with each heartbeat.

Dosage of B blocker(3)
Bisoprolol
1.25 mg QD

Carvedilol
3.125 mg BID

Metoprolol
12.5-25 mg QD

1. Eichhorn EJ, Bristow MR. Medical therapy can improve

the biolog- ical properties of the chronically failing heart:
a new era in the treatment of heart failure. Circulation
2007;94(9):22852296
2.http://emedicine.medscape.com/article/2172124overview

3. Summary of recommended guideline, chf standard

drug therapy.