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Heart failure, Inotropic Drugs, Beta blockers, ACE Inhibitors (ACEIs),…
Heart failure
Heart failure is a clinical syndrome characterized by
the inability of the heart to pump blood at a rate
commensurate with the metabolic needs of the body
or to do so only with elevated filling pressures.
Inotropic Drugs
Dobutamine
MOA: Selective β1 agonist, increases cardiac contractility by increasing cAMP levels in cardiomyocytes.
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ADRs: Tachycardia, arrhythmias, myocardial ischemia.
Dopamine
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ADRs: Hypertension, tachyarrhythmias.
Cardiac Glycosides (e.g., Digoxin)
MOA: Inhibition of Na+/K+-ATPase leading to increased intracellular calcium, enhancing myocardial contractility.
Uses: Rate control in atrial fibrillation, adjunct in chronic heart failure.
ADRs: Arrhythmias (especially with toxicity), nausea, visual disturbances.
Beta blockers
Carvedilol
MOA: alpha + β-blocker , reduces sympathetic tone, and improves myocardial function.
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ADRs: Bradycardia, hypotension, fatigue.
Metoprolol
MOA: Selective β1-blocker, reduces heart rate and myocardial oxygen demand.
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ADRs: Fatigue, dizziness, bradycardia.
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ACE Inhibitors (ACEIs)
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Effects: Reduce Angiotensin II, Lower Blood Pressure
Examples: Enalapril, Lisinopril, Ramipril
Diuretics
Loop Diuretics (e.g., Furosemide)
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ADRs: Hypokalemia, dehydration, ototoxicity.
MOA: Inhibit Na+/K+/2Cl- cotransporter in the ascending loop of Henle, leading to diuresis.
Thiazide Diuretics (e.g., Hydrochlorothiazide)
MOA: Inhibit Na+/Cl- cotransporter in the distal convoluted tubule, promoting diuresis.
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ADRs: Hypokalemia, hyperuricemia.
ACE Inhibitors/ARBs
ACE Inhibitors (e.g., Enalapril)
MOA: Inhibit angiotensin-converting enzyme, reducing angiotensin II levels and aldosterone secretion.
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ADRs: Hyperkalemia, cough, angioedema.
ARBs (e.g., Losartan)
MOA: Block angiotensin II receptors, similar to ACE inhibitors but without affecting bradykinin.
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ADRs: Hyperkalemia, hypotension.
SGLT-2 Inhibitors
Empagliflozin
MOA: Inhibits sodium-glucose cotransporter 2 in proximal renal tubules, reducing sodium and glucose reabsorption.
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ADRs: Genital infections, volume depletion.
Dapagliflozin
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ADRs: Urinary tract infections, hypotension
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Types of Heart Failure
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Decreased contractility leading to reduced ejection fraction (e.g., ischemic heart disease, dilated cardiomyopathy)
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Impaired ventricular relaxation or compliance (e.g., hypertension, hypertrophic cardiomyopathy)
Compensatory Mechanisms
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Release of natriuretic peptides (e.g., ANP, BNP)
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Natriuretic Peptides
Nesiritide
MOA: Recombinant B-type natriuretic peptide (BNP), promotes vasodilation and diuresis.
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ADRs: Hypotension, headache
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Vericiguat
MOA: Stimulates soluble guanylate cyclase, leading to increased cyclic GMP and vasodilation.
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ADRs: Hypotension, anemia
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Renin Inhibitors
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Effects: Reduce Angiotensin I & II, Lower Blood Pressure
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Aldosterone Antagonists
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Effects: Promote Sodium and Water Excretion, Retain Potassium
Examples: Spironolactone, Eplerenone
Beta-Blockers
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Effects: Lower Heart Rate, Reduce Renin Activity, Lower Blood Pressure
Examples: Propranolol, Metoprolol, Atenolol
Clinical Implications
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Reduce Cardiac Workload, Improve Survival Rates
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Protect Renal Function, Reduce Glomerular Hypertension and Proteinuria
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