DRUGS USED IN THE

TREATMENT OF
CONGESTIVE HEART
FAILURE
CHF :
COP does not meet the needs of the tissue.

The therapeutic goal: ( COP)

-  the cardiac muscle strength
-  ECF vol. (diuretic)

Note: vasodilator   the load on myocardium

 Cardiac Failure

Venous pressure Cardiac output

 Sympathetic activity  Blood pressure

 Renal blood flow

 Renin, angiotensin II

 Aldosteron

capillary filtration  Sodium retention

Edema
 Diuretics
• contractility •  afterload 
of cardiac •  ECF volume  CO
muscle     preload 
CO  edema
Inotropic
Vasodilator
Agents
 • Furosemid
Diuretics

• ACEI
Vasodilators • CCB
 Therapeutic use of glycosides is
confounded by:
1. Variable pharmacokinetics
2. Numerous drug interaction
3. Narrow therapeutic index
>< membrane Modifying Sympathetic
Na+ /K+ ATP ase activity

 Intracellular Na+ & Ca+

Myofibril contraction  rate of

impulse
(inotropic +) by SA-node
(chronotropic -)

 Cardiac output
depress High level 
conduction via AV-node

-Adrenoceptor
V.Constriction   PR
 GIT
Anorexia, nausea, vomiting, abdominal pain
 VISUAL
Disturbed color vision (green or yellow halo around lights)
 PSYCHIATRIC
Delirium, fatigue, malaise, confusion, dizziness, Abn dream
 RESPIRATORY
Ventilatory response to hypoxia

 CARDIAC
Dysrhytmia,
Ventricular fibrillation and cardiac arrest are the most
common causes of death
 Serum electrolyte abnormalities:
Hypokalemia
Hypomagnesia
Hypercalcemia
 Acid base imbalance
 Thyroid (hypothyroid)
 Renal failure
Digitalis level may  Amiodarone
Erythromycin base
Quinidine
Tetracycline
Verapamil

Enhanced potential
for cardiotoxicity

Corticosteroids
Thiazide diuretics
 levels of Loop diuretics
Blood K+
I. Dopamine

Stimulated effect on the:

 receptor  inotropic
chronotropic
Dopamine receptor   blood flow to the
kidney, viscera
 receptor  vasoconstriction
Indication: - Refractory Cardiac Failure
- Cardiogenic Shock
II. Dobutamin

Asynthetic analog of dopamin

 Cardiac Output

Indication:
- Refractory Heart Failure
- Severe acute myocardial failure
(after cardiac surgery)
- Cardiogenic shock
I. Loop Diuretics:
Furosemid, Bumetamid
II. Thiazide Diuretics:
Chlorothiazide, Hydrochlorothiazide
III. Potassium Sparing Diuretics:
Spironolactone
EFFECT
 Relieve peripheral edema
 Relieve pulmonary congestion  symptoms:
orthopnea, paroxysmal nocturnal dyspnea.
 Decreased plasma preload  cardiac load and
O2 demand afterload  BP
 Hypokalemia
 Angiotensin II  bradikynin  sympathetic
activities

Vasodilatation  aldosteron

 afterload  water & Na retention

 preload

CO  hypertrophy edema
remodeling heart & vasc.
 DOC HT
 CHF (left ventricular dysfunction)
 Patient who have had a recent myocardial
infarction
 Losartan • Eprosartan
 Condersartan • Tazosartan
 Valsartan • Telmisartan
 Iberstan • Zolasartan
 Vasodilator --- Ind: HT with heart
disfunctions
 Golongan:
1. Verapamil
2. Diltiazem
3. Dihidropiridin
- Nifedipine
- Amlodipine
- Ticlodipine
- Etc ...