文档介绍：Chapter 26 Anti-congestive heart failure drugs
LNMU Pharmacology
Chronic or Congestive Heart Failure,CHF
CHF occurs when the cardiac output is inadequate to provide the oxygen needed by the body.
The key defect in CHF is a decrease in cardiac contractility, resulting in inadequate cardiac output
The Causes of Heart Failure
Population-attributable risk,%
0
10
20
30
40
50
60
70
Male
Female
60
39
34
10
11
5
8
6
4
4
7
5
Hyper- Myo- Angina Diabetes LV heart Valvular
tension cardial hyper- heart
infarction trophy disease
The characterizations of CHF
Decrease in cardiac contractility, inadequate cardiac output.
Intravascular volume expansion and ventricular filling pressures↑, systemic and pulmonary hypertentension, dyspnea呼吸困难.
Activation of sympathetic nervous and RAS
Myocardial dysfunction.
Ventricular remodeling.
Ventricular remodeling after acute infarction
Ventricular remodeling in diastolic舒张 and systolic收缩 heart failure
Initial infarct
Expansion of infarct
(hours to days)
Global remodeling
(days to months)
Normal heart
Hypertrophied heart
(diastolic heart failure)
Dilated heart
(systolic heart failure)
Myocardial remodeling in Calcineurin transgenic hearts
(Cell, Vol 93, 215-228,1998)
Heart failure
Reduced cardiac output
Sympathetic nervous
system activation
Vasoconstriction
Elevated cardiac
filling pressure
Sodium and water
retention
Angiotensin Ⅰ
Renin
Cardiac remodeling
Aldosterone
AngiotensinⅡ
Pathophysiological mechanisms of heart failure and major sites of drug action
digoxin
β-blockers, digoxin
Vasodilators
ACE inhibitors
Angiotensin-R blockers
Diuretics
Spironolactone
Classification of drugs used in CHF
1. Renin-angiotensin-aldosterone system inhibitors
(1) ACEI captopril
(2) angⅡ receptor blocker (AT1 antagonist) losartan
(3) aldosterone antagonist spironolacton
2. Diuretics thiazides, furosemide
3. -receptor blocker Metoprolol, carvedilol
4. positive inotropic agents
(1)Cardiac glycosides