Feb 14, 2023
The drugs used in the treatment of acute and chronic congestive heart failure (CHF) are an important topic for the NEET PG exam since CHF is a common and serious cardiac condition. It affects a large number of people globally, which makes it essential for medical students to understand the drugs used to treat the condition.
Read this blog to get a quick overview of this high-yield pharmacology topic and strengthen your NEET PG/NExT Exam preparation.
It is a chronic condition in which the heart doesn’t pump blood properly. Hence, fluid accumulates in the back of the heart. This leads to congestive symptoms like
Drugs Used in the Case of Acute CHF
They will remove the pulmonary edema very quickly.
They can be β1 agonists like:
There may be phosphodiesterase inhibitors (also known as inodilators) like:
When a person has acute CHF, the body starts compensatory mechanisms. It will increase sympathetic activities as the heart is not pumping properly. Hence, in acute CHF, when there is low cardiac output, it increases the sympathetic activities which ultimately increases the production of catecholamines like adrenaline, noradrenaline etc. This will stimulate the β1 receptors which will eventually maintain the cardiac output.
The β1 overactivity in the JG cells of the kidney, will lead to the release of renin. Renin converts angiotensinogen into angiotensin first. Angiotensin first is converted into angiotensin second with the help of the enzyme ACE. Angiotensin second then stimulates the AT1 receptors which are present at several places. This can lead to vasoconstriction, release of aldosterone and release of catecholamines like adrenaline, noradrenalin etc.
Aldosterone that has been released will lead to
Problems with sympathetic over-activity
Hence in chronic CHF, inotropic drugs do not play a major role in the treatment. In chronic CHF, the aim of the treatment will be the following:
Inotropic drugs are given only if the patient hasn’t gotten better even after compensatory mechanisms.
Work of heart is decreased by administering vasodilators like -
Drugs that remove fluid retention are loop diuretics.
Drugs that prevent the left ventricular hypertrophy decreases the mortality/ increase the longevity of the person. No other drug decreases mortality. This is done by 4 types of drugs:
A combination of ACE (“pril”) inhibitor and NEP inhibitor (“tril”) has been developed. This is known as Patrilats like omapatrilat and sanpatrrilat. They have the property of both ‘prils’ and ‘trils.’
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