Medicines for heart failure: Features and notes when using

The article was professionally consulted by MSc Vu Thi Tuyet Mai - Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital. The doctor has over 13 years of experience in the diagnosis and treatment of cardiovascular diseases.

Heart failure is a weakened heart condition that is no longer able to pump blood enough to supply oxygen to the whole body, a consequence of many cardiovascular diseases. Treatment drugs aim to reduce the burden on the heart, increase blood supply to the heart to meet the oxygen demand of the whole body, prevent cardiovascular events, and reduce mortality.

1.1. Angiotensin-converting enzyme inhibitors (ACEIs) ACE inhibitors are the first choice in the treatment of heart failure, not only reducing symptoms but also improving prognosis significantly. Effects: These drugs inhibit the conversion of Angiotensin I into Angiotensin II, dilate blood vessels, lower blood pressure, reduce afterload and preload, thereby reducing the burden on the heart. In addition, the drug has also been shown to improve endothelial function, improve left ventricular function... ACE inhibitors include: Captopril, Enalapril, Lisinopril, Ramipril, Trandolapril, Perindopril. Note when using: The most common undesirable effect is a dry cough due to increased bradykinin synthesis, sometimes patients cannot take the drug due to a lot of dry cough. Notify your doctor if your cough is very dry. Contraindications: Bilateral renal artery stenosis, pregnant women, hyperkalemia. Caution should be exercised when using ACE inhibitors with potassium-sparing diuretics or in patients with low blood pressure.

1.2. Angiotensin AT1 receptor blockers are angiotensin-converting vasodilators and are the first choice for the treatment of heart failure in patients who are intolerant of ACE inhibitors. These drugs directly inhibit the AT1 receptor where angiotensin II causes effects on target tissues (vascular, kidney, heart...). On the other hand, the drug does not increase bradykinin, so it does not cause symptoms such as dry cough. The receptor blockers include: Valsartan, Candesartan, Losartan; Note: Contraindications: Bilateral renal artery stenosis, pregnant women, hyperkalemia. 1.3. Dual Angiotensin-Neprilysin Receptor Inhibitors (ARNIs) Dual receptor blockers including Sacubitril/Valsartan are indicated for the treatment of patients with chronic heart failure, as an alternative to ACE inhibitors or angiotensin receptor blockers if did not respond to these groups. Note: Contraindications and cautions: history of angioedema with ACE inhibitors, renal failure, bilateral renal artery stenosis, pregnant women... 1.4. Beta-blockers Beta-blockers have become an important, first-line option for improving survival, reducing hospitalizations for exacerbations, and reducing sudden cardiac death.

Indicated in case of chronic heart failure with reduced left ventricular ejection fraction. There are four types of beta-blockers on the market that can be used in the treatment of heart failure: carvedilol; metoprolol, bisoprolol and nevibolol. Note: Contraindications: congestive heart failure, bradycardia, bronchial asthma... Using beta-blockers in the treatment of heart failure must always consider contraindications carefully, should start with a very low dose, monitor closely and gradually increase the dose slowly. 1.5. Aldosterone-resistant diuretics Aldosterone-resistant diuretics reduce mortality and hospitalization in patients with severe heart failure. Aldosterone antagonists are not only diuretic, but are especially resistant to aldosterone elevation in severe heart failure, reducing vasoconstriction, salt and water retention, myocardial hypertrophy, renal failure, and endovascular dysfunction. .. Note: Contraindications and cautions: severe renal failure, hyperkalemia.

2.1. Diuretics Increase salt water excretion, help relieve symptoms of congestive heart failure, can be indicated for all stages of heart failure if congestive heart failure. Diuretics include thiazide diuretics, loop diuretics. Thiazide diuretics group: Chlorothiazide, Hydrochlothiazide, Metolazone, Indapamide... Group of diuretics acting on Henle loops (Furosemide, Bumetanide, Ethacrynic acid...): Furosemide is especially effective in treating patients with heart failure. severe or acute pulmonary edema.

2.2. Cardiac Glucoside (Digoxin) Low-dose digoxin is effective in reducing symptoms and hospital readmission rates in chronic heart failure. Indications: Heart failure with low cardiac output, dilated cardiomyopathy, especially in the presence of tachycardia; heart failure associated with supraventricular arrhythmias, especially in atrial fibrillation or flutter. Note: High doses of digoxin according to the classical administration (load and maintenance doses) may increase mortality and are not currently recommended. Contraindications: Bradycardia; atrioventricular block - second and third degree without pacemaker; ventricular arrhythmias; Wolff - Parkinson - White syndrome; obstructive hypertrophic cardiomyopathy; aortic stenosis or severe pulmonary stenosis. Caution in cases of: acute myocardial infarction and electrolyte disturbances, caution when used in combination with amiodarone drugs; quinidine; calcium... 2.3. If channel blocker (Ivabradine) has the effect of reducing sinus rhythm, reducing the rate of death from cardiovascular causes and re-hospitalization due to heart failure. Recommended for patients with heart failure with EF < 35%, sinus rhythm, heart rate > 70 beats/min despite optimized treatment of heart failure with beta-blockers, ACE inhibitors, aldosterone antagonists without response Note: contraindications bradycardia. 2.4. Combination of Hydralazine and Isosorbide dinitrate Indicated in patients with heart failure EF < 35% or EF < 45% with left ventricular dilatation, persistent NYHA III-IV dyspnea despite using other drug classes. Note: Alternative therapy to ACE inhibitors in cases of intolerance or contraindications to reduce mortality. To protect cardiovascular health in general and detect early signs of cardiovascular disease, customers can sign up for Cardiovascular Screening Package - Basic Cardiovascular Examination of Vinmec International General Hospital. The examination package helps to detect cardiovascular problems at the earliest through tests and modern imaging methods. The package is for all ages, genders and is especially essential for people with risk factors for cardiovascular disease.