Treatment of heart failure with drugs

Heart failure treatment involves the use of different classes of medications that help improve heart function, reduce symptoms, and improve a patient's quality of life. Here are the main classes of drugs that can be used for heart failure:

Angiotensin-converting enzyme inhibitors (ACEIs)

Angiotensin-converting enzyme inhibitors (ACEIs) are one of the important classes of drugs used in heart failure. They play a key role in the treatment of this condition and have the following beneficial effects:

1. Improved heart contractility: IAPs help improve the contractility of the heart, which means that the heart becomes more efficient at pumping blood around the body.
2. Vascular dilation: These drugs promote vasodilation, which reduces vascular resistance and decreases the workload on the heart.
3. Improve endothelial function: IAPs can help improve endothelial function (the inner layer of the vascular wall), which promotes more normal blood flow and reduces inflammation.
4. Reducing heart remodeling: IAPs may help prevent or slow the process of heart remodeling that occurs in heart failure and can lead to deterioration of the heart muscle.
5. Lowering blood pressure: These medications may help lower blood pressure, which is especially important in heart failure associated with hypertension (hypertensive heart failure).

Examples of IAPTs include the following drugs:

• Enalapril (Enalapril)
• Lisinopril (Lisinopril)
• Ramipril (Ramipril)
• Fosinopril (Fosinopril)
• Benzapril (Benazepril)
• Perindopril (Perindopril)

It is important to note that the use of IAPPs for heart failure should be prescribed and monitored by a physician. The dosage may depend on the specific characteristics of the patient and the degree of heart failure. It is also important to regularly monitor blood potassium levels, as IAPPs can increase potassium levels. You should never start or stop taking an IAPP without consulting your doctor.

Beta-adrenoblockers

Beta-adrenoblockers (beta-blockers) are a class of medications that can be used in the treatment of heart failure, especially when heart failure is accompanied by increased sympathetic nervous system activity. Beta-blockers work by blocking the action of norepinephrine and epinephrine (catecholamines), which stimulate beta-adrenergic receptors on the surface of heart cells and the vascular wall. Here's how beta blockers can be helpful in heart failure:

1. Reducing the strain on the heart: Beta-blockers can reduce the frequency and force of heart contractions, which reduces the strain on the heart. This is especially useful when the heart is working too hard and its efficiency is impaired.
2. Improvement of cardiac function: Prolonged use of beta-blockers may improve cardiac function by increasing myocardial contractility and reducing left ventricular workload.
3. Reducing sympathetic activation: Beta-blockers help reduce sympathetic nervous system activity, which can be excessive in heart failure. This can help reduce the contractility of the heart and prevent adverse reactions such as arrhythmias.
4. Improved quality of life: In some patients, beta-blockers may improve quality of life by reducing symptoms of heart failure such as shortness of breath, fatigue, and swelling.

It is important to note that the prescription and choice of beta-blockers, their dosage and treatment regimen should be carried out by a doctor based on the individual characteristics of each patient.

Diuretics

Diuretics are a group of medicines that help reduce fluid and salt retention in the body, which can be helpful in heart failure. They help reduce the workload on the heart by decreasing the amount of blood the heart has to pump and reducing swelling and pressure levels in the blood vessels. Diuretics may be used in the treatment of heart failure, especially if there is swelling and fluid retention in the body.

Here are some of the main types of diuretics that can be used for heart failure:

1. Thiazide diuretics: Examples include hydrochlorthiazide and chlorthalonil. They are usually used as first-line treatment for mild heart failure and may help reduce swelling.
2. Loop diuretics: Examples include furosemide and bumetanide. They are more powerful than thiazide diuretics and may be necessary in cases of more severe heart failure or edema.
3. Potassium-saving diuretics: Examples include spironolactone and eplerenone. They may be prescribed in combination with other diuretics to prevent the loss of potassium from the body, which may be important for heart health.
4. Aldosterone antagonists: An example is eplerenone. These medications block the action of the hormone aldosterone and may help manage salt balance and reduce the workload of the heart.

It is important to note that diuretics should be taken under the supervision of a physician, as they can cause changes in electrolyte balance (e.g., loss of potassium), which can have an impact on heart health. The dosage and type of diuretic will depend on the degree of heart failure and the patient's overall condition.

Aldosterone antagonists

Aldosterone antagonists are important medicines in the treatment of heart failure. They help improve the condition of patients by reducing the workload on the heart and preventing fluid retention in the body. The main aldosterone antagonist used in medical practice is called spironolactone. There are also its more modern analogs, such as eplerenone.

Here's how an aldosterone antagonist works in heart failure and the benefits it can provide:

1. Reducing sodium and water retention: Aldosterone promotes sodium and water retention in the body, which increases blood volume and the workload of the heart. Aldosterone antagonists help block this action, leading to a decrease in blood volume and pressure within the blood vessels.
2. Reducedstress on the heart: By reducing blood volume and pressure levels in the blood vessels, the heart is more efficiently able to pump blood throughout the body. This improves the heart's contractile function and reduces the work of the heart.
3. Improvement in symptoms: Patients with heart failure taking aldosterone antagonists often experience improvement in symptoms such as shortness of breath, swelling, and fatigue.
4. Life Extension: Studies have shown that the use of aldosterone antagonists in patients with heart failure can reduce the risk of death and improve prognosis.

It is important to note that the use of aldosterone antagonists should be monitored by a physician, as they can cause side effects such as hyperkalemia (elevated blood potassium levels) and impaired kidney function.

Cardiac glycosides

Cardiac glycosides, such as digoxin (a medication) or digitalis extracts from some plants, can be used in the treatment of heart failure. They work by increasing the force of heart contraction and controlling the heart's rhythm. Here's how cardiac glycosides work and when they are used in heart failure:

1. Increase the force of heart contraction: Cardiac glycosides increase the force of contraction of the myocardium (heart muscle). This can be helpful in heart failure, when the heart is unable to pump blood efficiently and maintain blood supply to organs and tissues.
2. Improved heart rhythm control: Cardiac glycosides may help control heart rhythm, especially in atrial fibrillation or some forms of arrhythmias.
3. Reduction of sympathetic nervous system activity: One mechanism of action of cardiac glycosides is to reduce sympathetic nervous system activity, which may be excessive in heart failure.

Cardiac glycosides should only be used under the strict supervision of a physician, as improper use or dosage can lead to serious side effects. The dosage should be fine-tuned to the patient's individual needs, and it is important to monitor cardiac glycoside blood levels.

Patients taking cardiac glycosides are recommended to regularly monitor their heart condition and follow the doctor's prescriptions. Independent change of dosage or discontinuation of the medicine without consulting a doctor should be avoided.

Vasodilators

Vasodilators are medicines that help dilate blood vessels and improve blood flow to organs and tissues. They can be useful in the treatment of heart failure because they help reduce the workload on the heart and improve its function. Below are some of the types of vasodilators that can be used in heart failure:

1. Nitrates: These drugs, such as nitroglycerin, can help dilate arteries and veins, lowering vascular resistance and reducing the preload on the heart. They may also help relieve chest pain from angina pectoris.
2. Hydralazines: Drugs in this class, such as hydralazine, can help dilate arteries and reduce arterial resistance. They are often used in combination with nitrates.
3. Phosphodiesterase-5 (PDE-5) inhibitors: These drugs, such as sildenafil (Viagra), dilate blood vessels and may help improve blood flow. They may be used for some forms of heart failure.
4. Hyperpolarizing vasodilators: Drugs in this class, such as ivabradine, can slow heart rate and reduce the workload of the heart without affecting blood pressure.
5. Selective alpha-adrenoblockers: These drugs can help dilate blood vessels and improve blood flow. However, they may be used with caution and under a doctor's supervision because of potential side effects.

The choice of vasodilator and dosage should be individualized and prescribed by the physician depending on the patient's characteristics and heart failure features.

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists (or ARA II) are a class of drugs that are often used to treat heart failure. They work by blocking the action of angiotensin II, which is a molecule that causes blood vessels to constrict and increase the workload of the heart. Here's how ARA IIs work and what their benefits may be in treating heart failure:

1. Vasodilation: ARA IIs help to dilate blood vessels, which can lower blood pressure and reduce the workload on the heart. This is particularly useful in heart failure, where vasoconstriction can make it more difficult to supply blood to organs and tissues.
2. Reducing the strain on the heart: By dilating the blood vessels and reducing pressure, the heart can work more efficiently and with less strain. This contributes to improved heart function.
3. Reducing salt and water retention: ARA IIs can also reduce salt and water retention in the body, which helps prevent swelling and improve patient well-being.
4. Improving kidney perfusion: This class of medications may help improve the blood supply to the kidneys, which is important for maintaining normal kidney function in heart failure.
5. Improving quality of life: ARA IIs may help improve patients' quality of life by reducing symptoms of heart failure such as shortness of breath, fatigue, and swelling.

Examples of ARA IIs are losartan, valsartan, and irbesartan. They are usually used in combination with other medicines to treat heart failure, such as ACE (angiotensin-converting enzyme) inhibitors, diuretics, and beta-adrenoblockers, depending on the individual patient's needs.

Treatment for heart failure should be individualized and prescribed by a doctor based on the specific needs of the patient and the characteristics of his or her condition. It is important to strictly follow the doctor's recommendations and regularly monitor the condition of the heart. You should never change the dosage or stop taking medication on your own without consulting your doctor.

Literature used

• Shlyakhto, E. V. Cardiology: national guide / ed. By E. V. Shlyakhto. - 2nd ed., revision and addendum - Moscow: GEOTAR-Media, 2021
• Cardiology according to Hurst. Volumes 1, 2, 3. 2023