Heart failure drugs药物.pptVIP

Chapter 26Drugs Used in Congestive Heart Failure Overview of congestive heart failure Congestive heart failure (CHF) is a condition in which the heart is unable to pump sufficient blood to meet the needs of body. Causes of CHF: coronary artery disease， hypertention, valvular heart disease(心瓣膜病), dilated cardiomyopathy(扩张性心肌病), and congenital heart disease(先天性心脏病) Activation of SNS increase myocardial contractility increase heart rate increase systemic vascular resistance Activation of RAS increase systemic vascular resistance increase production of aldosterone ----fluid retention Treatment of congestive heart failure 1. Positive inotropic drugs(正性肌力药) Cardiac glycosides Sympathomimetics Phosphodiesterase inhibitors 2. Diuretics: thiazides, aldosterone antagonists (spironolactone螺内酯) 3. Vasodilators 4. RAS inhibitors: ACEI, AT1 antagonist 5.β-receptor blocker Diuretics Diuretics remain central in controlling congestive symptoms and improving exercise capacity in patients with CHF Congestive symptoms: elevated right-heart pressure, pulmonary venous congestion, and peripheral edema Aldosterone Antagonists Spironolacton(螺内酯) In CHF， Plasma aldosterone concentrations may increase to as high as 20 times the normal level. Biological effects of aldosterone: Salt retention Myocardial fibrosis Reduced myocardial norepinephrine uptake Treatment with spironolacton is associated with mortality benefit in patients with heart failure (~30% reduction) Vasodilators Vasodilators may improve symptoms in heart failure Most vasodilator can hardly improve survival in CHF Renin-Angiotensin System Antagonists The renin-angiotensin system plays a central role in the pathophysiology of heart failure ACE inhibitors delay the progression of heart failure and improve mortality (~40% mortality reduction ) AT1 receptor antagonists can be viewed as the preferred alternative when ACE inhibitors cannot be tolerated ? Adrenergic Receptor Antagonists Heart failure is characterized