Congestive Heart Failure (cont.)
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Nitrates, Apresoline, Beta Blockers, and Inotropes Drugs for Congestive Heart Failure
Nitrates are venous vasodilators that include isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil). They are commonly used in combination with an arterial vasodilator, such as hydralazine (see below).
Hydralazine (Apresoline) is a smooth muscle arterial vasodilator that may be used for congestive heart failure. Clinical trial data has shown hydralazine plus nitrates to be especially effective in African-Americans with heart failure, when used in addition to ACE inhibitors or ARBs.
Beta-blockers: These drugs slow down the heart rate, lower blood pressure, and have a direct effect on the heart muscle to lessen the workload of the heart. Specific beta-blockers, such as carvedilol (Coreg) and long-acting metoprolol (Toprol XL), have been shown to decrease symptoms, hospitalization due to congestive heart failure, and deaths. Other beta-blockers include bispropolol (Zebeta), atenolol (Tenormin), propranolol (Inderal), and bystolic (Nebivolol), but they are generally not used with significant congestive heart failure.
Inotropes: IV inotropes are stimulants, such as dobutamine and milrinone, which increase the pumping ability of the heart. These are used as a temporary support of a very weak left ventricle that is not responding to standard congestive heart failure therapy. Commonly used inotropes are dobutamine (Dobutex) and milrinone (Primacor). Phenylephrine (Neo-Synephrine) may be used when a patient is suffering with severe low blood pressure.
ACE inhibitors and ARBs may cause the body to retain potassium, but this is generally only a problem in people with significant kidney disease, or in people who are also taking a potassium-sparing diuretic, such as triamterene or spironolactone. Potassium levels can be monitored with lab testing.
Calcium channel blockers (CCBs) are arterial vasodilators that are not used for treatment of heart failure because clinical trials have proven no specific benefit. However, calcium channel blockers are useful for lowering blood pressure. If the cause of the congestive heart failure is high blood pressure and the patient is not responding to ACE inhibitors or ARBs, a CCB may be considered. Some CCBs include diltiazem (Cardizem), verapamil (Calan, Isoptin), nifedipine (Procardia, Adalat), and amlodipine (Norvasc).
These above-mentioned medications can be very effective in treatment of patients with systolic heart failure. There are not many successful therapies proven with clinical trial results available for patients with diastolic heart failure. Patients with diastolic heart failure are often prescribed these medications to treat their underlying conditions, such as hypertension or coronary disease, and as an extrapolation of favorable results, in the treatment of systolic heart failure. Several clinical trials are ongoing.
The medications listed above are very commonly used, but other mediations may be prescribed depending on the underlying cause of the heart failure or medical condition.
Getting the most out of congestive heart failure medications involves the following:
Medically Reviewed by a Doctor on 8/31/2017
Terrence X O'Brien, MD, FACC
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Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues and/or pumps only from an abnormally elevated diastolic filling pressure.