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Heart Failure

Heart failure is a condition in which cardiac output is insufficient for the needs of the body. This decrease in the cardiac output may be due to any structural or functional disorder of heart that affects its ability to fill with blood badly.Heart failure is caused by any condition which reduces the efficiency of the myocardium, or heart muscle, through damage or overloading. It may result from many other complex disorders such as myocardial infarction,hypertension or amyloidoses.

The homeostatic responses of body to decreased cardiac output are mediated by sympathetic nervous system and renin angiotensin aldosteron system. Responses produced are
1- Tachycardia
2- Increased peripheral resistance
3- Increased sympathetic tone
4- Retention of salt and water by kidneys
5- Increased blood volume leads to edema and pulmonary congestion
6- Increased end-diastolic fiber length
Cardiomegaly is a slow compensatory response.

Types of heart failure:

There are different types of heart failure,the common ones are
1) Left or right heart failure
2) Congestive heart failure
3) Acute or chronic heart failure
4) Compensated and decompensated heart failure
5) High and low output heart failure

Low output failure is more common and more responsive to drugs than high output failure.

Drugs used in Heart failure:

a) cardiac glycosides - Digitalis
b) Bipyridines - phosphodiestrase inhibitors
i. Inamrinone
ii. Milrinone
c) beta adrenoceptors stimulants - Dopamine and dobutamine
Dobutamine is selective beta 1 agonist and causes increase in cardiac output and decrease in ventricular filling pressure. Dopamine is used in acute heart failure to increase the blood pressure.
d) Diuretics
e) ACE inhibitors - Captopril
f) Angiotensin receptor antagonists - Losartan,Omapatrilat
g) Vasodilators - Hydralazine,nitroprusside,isos orbide nitrate,Nesiritide and Bosentan(not impressive in humans)
Venodilators cause decrease in preload
Arteriolar dilators cause decrese in afterload or both.
h) Beta adrenoceptor blockers - Metoprolol,Carvedilol,bisoprol ol.

During acute heart failure drugs used commonly are: loop diuetice + Beta agonists + vasodilators.
During chronic Heart failure drugs used are: Diuretics( loop diuretics + spironolactone)+ ACE inhibitors + Beta-blockers
During systolic dysfunction Digitalis is used.

Treatment Strategies:

Sedentary lifestyles should be avoided.Regular exercise should be done for fitness and health.
Weight should be controlled. avoid obesity,take light and simple food instead of fatty fast foods.
Remove salt and water with diuretics
Positive inotropic - Digitalis
Decrease preload and afterload with vasodilators
Decrease afterload and salt water with ACE inhibitors
Beta-adrenoceptors blockers and spironolactone - aldosterone antagonist show long term benefits.

However, if the pharmacological strategy fails then heart implantation is the solution left.It is risky and a difficult procedure but at the sake of one's life,nothing is impossible.
Protect and care your heart from all hazards and avoid tensions.

Learn more about this author, Hadia Ali.
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