HEART FAILURE DRUGS
HEART FAILURE
• Not a specific disease
• Complex clinical syndrome resulting from any functional or structural
impairment to the heart, specifically ejection of blood or ventricular filling
• Inability for heart to pump effectively related to the muscles of the
heart
• Heart becomes “Decompinsated”
• The heart is unable to pump blood in sufficient amounts from the ventricles
to meet the body’s metabolic needs.
• Causes of Heart Failure
• High BP (Hypertension)
• Strain on heart over time
• Left Ventricle has to pump really hard
• Initially becomes larger
• Slowly the muscle fibers become stretched and ineffective
(Starling’s Law)
• Afterload – Pressure that our heart has to beat out
against (into body)
• BP
• Can be high BP, PUR SVR
• Hypertension has INCREASED Afterload
(SVR)
• Heart Attack (MI)
• Stopped the blood flow to a portion of the heart
• #DEAD
• NEVER REGAINS FULL FUNTION AGAIN
• Heart not as effective (Minimal – Extreme)
• Heart Valves not working properly
• 2 types of Heart Valve Probs
• Regurgitation
• Doesn’t close properly
• Stenosis
• Open but open really hard to open
• Obesity
• Excess strain on heart over time
• Heart failure patients on multiple meds for multiple reasons…not just
one reason or one med
• Symptoms depend on the cardiac area affected
• “Left-sided” heart failure (HF): pulmonary edema, coughing,
shortness of breath, and dyspnea
• Left Ventricle not pumping out to body well
• Neurological Props from this
• Confusion, Lethargy, Dizzy
• Not good blood flow to Kidney’s
• Decreased Function
• Decreased Urine Output
• Delayed Capillary Refill
, • Cool Pale Skin
• Where does blood back up into?
• Left atrium…..The LUNGS
• Pulmonary Edema
• “Right-sided” HF: systemic venous congestion, pedal edema, jugular
venous distension, ascites, and hepatic congestion
• Blood is coming from the
• Vena Cava….coming back from the periphery
• PRELOAD
• Pressure/Volume that is filling the heart
• Determines cardiac output
• Too much Preload
• Overstretches muscles…..then they don’t
pump as well
• How to decrease preload?
• Diuretics
• Results
• Swollen ankles
• Swollen abdomen
• Fluid build up in organs
CONDUCTION SYSTEM OF THE HEART
60-100bpm is normal heart rate
o Not the absolute – Doesn’t mean there is an
abnormality
o “What is normal for the patient”
AV Node
o Slows the electrical conduction so that
ventricles can full completely
STAGE A: At high risk for Heart Failure but no
symptoms or structural heart disease
STAGE B: Structural heart disease but no symptoms
STAGE C: Structural heart disease with symptoms
STAGE D: Refractory HF requiring interventions
Don’t have to know this ↑
DRUG THERAPY FOR HEART FAILURE
• Positive inotropic drugs:
• increase the force of myocardial contraction
• Negative Inotropic Drug Inotropic
• Decreases Force of Contraction
• Beta Blockers Changes Contractility
• Given to many patients
• Positive chronotropic drugs:
Chronotropic
• increase heart rate Changes Heart Rate
• Epinephrine
Dromotropic
• For most Heart Failure patients you want to slow the heart rate
Changes Conduction
2
HEART FAILURE
• Not a specific disease
• Complex clinical syndrome resulting from any functional or structural
impairment to the heart, specifically ejection of blood or ventricular filling
• Inability for heart to pump effectively related to the muscles of the
heart
• Heart becomes “Decompinsated”
• The heart is unable to pump blood in sufficient amounts from the ventricles
to meet the body’s metabolic needs.
• Causes of Heart Failure
• High BP (Hypertension)
• Strain on heart over time
• Left Ventricle has to pump really hard
• Initially becomes larger
• Slowly the muscle fibers become stretched and ineffective
(Starling’s Law)
• Afterload – Pressure that our heart has to beat out
against (into body)
• BP
• Can be high BP, PUR SVR
• Hypertension has INCREASED Afterload
(SVR)
• Heart Attack (MI)
• Stopped the blood flow to a portion of the heart
• #DEAD
• NEVER REGAINS FULL FUNTION AGAIN
• Heart not as effective (Minimal – Extreme)
• Heart Valves not working properly
• 2 types of Heart Valve Probs
• Regurgitation
• Doesn’t close properly
• Stenosis
• Open but open really hard to open
• Obesity
• Excess strain on heart over time
• Heart failure patients on multiple meds for multiple reasons…not just
one reason or one med
• Symptoms depend on the cardiac area affected
• “Left-sided” heart failure (HF): pulmonary edema, coughing,
shortness of breath, and dyspnea
• Left Ventricle not pumping out to body well
• Neurological Props from this
• Confusion, Lethargy, Dizzy
• Not good blood flow to Kidney’s
• Decreased Function
• Decreased Urine Output
• Delayed Capillary Refill
, • Cool Pale Skin
• Where does blood back up into?
• Left atrium…..The LUNGS
• Pulmonary Edema
• “Right-sided” HF: systemic venous congestion, pedal edema, jugular
venous distension, ascites, and hepatic congestion
• Blood is coming from the
• Vena Cava….coming back from the periphery
• PRELOAD
• Pressure/Volume that is filling the heart
• Determines cardiac output
• Too much Preload
• Overstretches muscles…..then they don’t
pump as well
• How to decrease preload?
• Diuretics
• Results
• Swollen ankles
• Swollen abdomen
• Fluid build up in organs
CONDUCTION SYSTEM OF THE HEART
60-100bpm is normal heart rate
o Not the absolute – Doesn’t mean there is an
abnormality
o “What is normal for the patient”
AV Node
o Slows the electrical conduction so that
ventricles can full completely
STAGE A: At high risk for Heart Failure but no
symptoms or structural heart disease
STAGE B: Structural heart disease but no symptoms
STAGE C: Structural heart disease with symptoms
STAGE D: Refractory HF requiring interventions
Don’t have to know this ↑
DRUG THERAPY FOR HEART FAILURE
• Positive inotropic drugs:
• increase the force of myocardial contraction
• Negative Inotropic Drug Inotropic
• Decreases Force of Contraction
• Beta Blockers Changes Contractility
• Given to many patients
• Positive chronotropic drugs:
Chronotropic
• increase heart rate Changes Heart Rate
• Epinephrine
Dromotropic
• For most Heart Failure patients you want to slow the heart rate
Changes Conduction
2
