Posted by e-Medical PPT
Drug management aims to provide symptomatic relief  for the patient while also preventing further deterioration in cardiac function

Effective at treating & controlling fluid retention, but do not prevent disease progression.
If used alone can stimulate renin-angiotensin system & accelerate disease process

Loop Diuretics
Reduce symptoms of congestion by reducing preload
Act on Ascending Loop of Henle to increase the secretion & inhibit reabsoprtion of Na, Chloride and H2O
Long term use lowers B/P by arteriolar vasodilatation
Less likely to cause worsening renal function than Thiazides

Thiazide Diuretics
Prevent Na reabsorption by kidneys
Cause reduced blood volume
Long-term use lowers B/P, by arteriolar vasodilatation

Cautions with Diuretics
Hypokalaemia & low Mg
Hypovolaemia & hypotension
Drug Interaction – reduce hypoglycaemic effect of oral hypoglycaemics > hyperglycaemia
Increased concentration Lithium

ACE Inhibitors
Cornerstone of heart failure management
Blockade of the renin-angiotensin-aldosterone system
Decrease cardiac preload & afterload
Prevention of ventricular remodelling
Approximately 7000 patients evaluated in placebo-controlled clinical trials
Consistent improvement in cardiac function, symptoms and clinical status
Decrease in all-cause mortality by 20-25%
Decrease in combined risk of death and hospitalisation by 20-25%

Beta Blockers
Activation of the sympathetic nervous system is a contributory factor in the pathophysiology of heart failure.
Beta Blockers prevent stimulation of the sympathetic nervous system by inhibiting the action of catecholamines (noradrenaline and adrenaline) at beta-adrenergic receptors.

Effects In Heart Failure
Reduce mortality and morbidity
Improve Left Ventricular function & symptoms
Reduce hospital admissions

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