Definition
Heart failure is a disease in which the heart muscle, and therefore the heart, does not have enough strength to pump the blood needed to meet the body's metabolic needs.
Heart failure generally presents itself as a progressive disease that gradually worsens over time. In some cases, however, the disease can also occur in acute form.
Causes
The causes of heart failure can be different. However, it often happens that the pathology is not caused by a single factor, but by a set of predisposing factors that damage the heart by altering its functionality.
Among these factors we find: previous myocardial infarctions, hypertension, heart valve disorders, myocarditis, arrhythmias, thrombosis or atherosclerosis with aortic stenosis and other cardiovascular diseases.
Furthermore, heart failure can also be caused by alcohol abuse, allergic reactions, heart infections, or other types of illness, such as anemia, diabetes, hypothyroidism or hyperthyroidism and systemic lupus erythematosus.
Symptoms
The first symptoms that appear in case of heart failure are rather non-specific and consist of dyspnea, fatigue and peripheral edema. At the most advanced stage, however, specific symptoms may appear, such as orthopnea and jugular congestion.
Other symptoms that may occur in patients with heart failure are respiratory acidosis, adinamia, anasarca, cardiac arrhythmias, liver congestion, extrasystoles, atrial or ventricular fibrillation, hyperkalemia, hyperventilation, hyponatremia, hypoxia, wheezing, drowsiness, confusion, cough, tachypnea and pleural effusion.
Information on Heart Failure - Drugs and Care is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Heart Failure - Drugs and Care.
drugs
Treatment of heart failure involves drug therapy and some changes in patients' lifestyle. Individuals with heart failure, in fact, must be at rest and must follow a low-salt diet. Drug treatment, on the other hand, involves the administration of drugs capable of reducing the symptoms induced by the disease and able to help the heart to carry out its activity.
In some cases, moreover, the doctor may consider it necessary to resort to surgical treatment.
ACE-inhibitors
ACE inhibitors perform their action by inhibiting the angiotensin-converting enzyme (English: Angiotensin Converting Enzyme, or ACE). They are vasodilators that work by reducing the workload of the heart. They can be useful in the treatment of heart failure and in preventing the symptoms associated with it, thus improving the quality of life of patients suffering from it.
- Enalapril (Enapren ®, Converten ®): the initial amount of enalapril usually used by mouth is 2.5 mg a day. Later, the doctor will gradually increase the daily dose of the drug, until the most suitable dosage is reached for each patient. The maintenance dose usually used is around 20-40 mg of enalapril per day.
- Lisinopril (Zestril ®): the dose of lisinopril usually administered orally is 5-20 mg a day. The exact amount of the drug you need to take will be determined by your doctor.
- Ramipril (Triatec ®): the initial dose of ramipril usually used orally is 1.25-2.5 mg a day. Thereafter, the doctor may increase the amount of medication to be taken, up to a maximum of 10 mg a day.
- Perindopril (Coversyl ®): the dose of perindopril usually administered is 2.5-10 mg of drug per day, to be taken orally. The amount of drug to be used must be established by the doctor depending on the patient's condition.
Sartani
The sartans who play an antagonistic action against angiotensin II receptors (a peptide hormone that promotes and stimulates vasoconstriction). They are, therefore, vasodilator drugs that act in a similar way to ACE inhibitors. In fact, the sartans are often used in the treatment of heart failure in those patients who do not tolerate the treatment based on ACE inhibitors.
Sartans can be administered either alone, or in combination with diuretics and / or beta-blockers.
- Losartan (Losapre ®, Neo-Lotan ®, Lastan ®, Lorista ®): the initial dose of losartan usually administered orally is 12.5 mg per day. Subsequently, the doctor will gradually increase the dose of the drug until the optimal dose is reached for each patient.
- Valsartan (Tareg ®): the usual starting dose of valsartan is 40 mg, to be taken orally twice a day. Later, the doctor will increase the dose of the drug administered until the optimal dose is reached for the patient, taking care not to exceed the maximum quantity of 160 mg of active ingredient per day.
- Telmisartan (Micardis ®, Pritor ®, Telmisartan Teva ®, Telmisartan Actavis ®, Telmisartan Teva Pharma ®): the dose of telmisartan usually used in therapy is 20-80 mg of active ingredient per day, to be taken orally. However, the amount of drug to be used must be established by the doctor on an individual basis.
Beta blockers
Beta-blockers can be used to treat heart failure because they reduce the symptoms it induces and improve heart function.
- Carvedilol (Dilatrend ®): when used in the treatment of heart failure, the initial dose of carvedilol usually administered is 3.125 mg, to be taken twice a day orally. Subsequently, the doctor may decide to increase the amount of drug to be administered until the optimal dose is reached for each patient.
Digoxin
Digoxin (Lanoxin ®) is a digitalis glycoside that exerts a positive inotropic effect, ie it is able to increase the strength of cardiac contraction.
When administered orally, the dose of digoxin usually used in adults and children over 10 years of age is 0.25-1.5 mg a day, to be taken in a single dose, or in divided doses.
Diuretics
Diuretics are used in the treatment of heart failure to reduce edema caused by the disease itself. Among the various active ingredients that can be used, we recall:
- Hydrochlorothiazide (Esidrex ®): hydrochlorothiazide is a diuretic belonging to the thiazide class. The dose of medication to be taken orally should be established by the doctor for each patient, taking care not to exceed the maximum dose of 50 mg of hydrochlorothiazide per day.
- Acetazolamide (Diamox ®): acetazolamide belongs to the class of diuretics carbonic anhydrase inhibitors. The dose of medication usually used orally is 250-375 mg per day. The exact dosage of the medicine must however be established by the doctor.
- Furosemide (Lasix ®): the dose of medication usually administered orally in adults is 25-75 mg. Depending on the patient's response to therapy, the doctor may decide to administer the same amount of furosemide after four hours. It should be remembered, however, that the use of furosemide is not indicated in patients with hypokalemia and / or hyponatremia.
Receptor antagonists for aldosterone
These drugs act in a similar way to diuretics, therefore, they are useful in reducing edema caused by heart failure, but not only. In fact, aldosterone receptor antagonists reduce the risk of patient hospitalization and may favor a prolongation of life. Among these drugs we mention spironolactone (Spirolang ®). In the treatment of heart failure, the dose of spironolactone usually administered orally is 100-200 mg a day, to be taken in divided doses.
