Drugs Used in Heart Failure

Congestive heart failure (CHF) is a systolic dysfunction of the heart in which the pumping efficiency or ejection fraction reduces and the body responses by compensatory mechanisms. Sympathetic activation and activating the RAAS help in the short run but are deleterious in the longer run and cause myocardial remodeling and apoptosis. Drugs which remove these stressors usually reduce mortality such as RAAS inhibitors, beta-blockers, mineralocorticoid antagonists and a combination of hydralazine and isosorbide dinitrate. Drugs which act to reduce congestion and other symptoms reduce preload (diuretics, nitrates) and afterload (RAAS inhibitors). Digoxin works uniquely by stimulating the heart but its use has come down because of its narrow therapeutic window and availability of better drugs. Newer agents include recombinant atrial natriuretic peptide and vasopeptidase inhibitors. Decompensated heart failure is treated by inotropic agents such as dopamine, dobutamine, and phosphodiesterase inhibitors.