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Flashcards in Pharmacological Management of Heart Failure Deck (18):

Compensatory Hypertrophy vs Cardiac Failure

Compensatory Hypertrophy keeps an increased LV diastolic volume with no increased wall stress. Cardiac failure has a greatly increased LV diastolic volume (increased radius) and increased wall stress for both systole and diastole.


Most Prevalent Primary cause of HF

Coronary Artery Disease (CAD) 60% of cases.


New York Heart Association Classifications of Cardiac Function Status

• Class I No limitations, no symptoms with ordinary activities
•  Class II Slight limitations; symptoms with ordinary activities
•  Class III marked limitations: symptoms with < ordinary activities
•  Class IV Symptoms of cardiac insufficiency at rest


(T or F) Heart Failure has an increased amount of Parasympathetic Stimulation.

False. Increased Sympathetic stimulation. Leads to pathological remodeling.


ACE Inhibitors and ARBs Target?

Heart, Kidneys and Blood Vessels



•  Perhaps the most important category of
drugs used in the treatment of heart failure
•  Nitrates
•  ACE-inhibitors
•  ARB’s (angiotensin receptor blockers)


RAAS Definition

Renin-Angiotensin-Aldosterone System. Angiotensinogen -> Angiotensin II which causes the production of aldosterone from the zona glomerulosa in the adrenal cortex.


Ang II stimulation pathway

Angiotensin II binds the AT-1 receptor. Activation causes stimulation of MAPK and ERK 1/2. This leads to stimulation of TGF-Beta, AP-1 , collagen 1 and fibronectin. Also causes changes in the actin filament dynamics. This leads to vasoconstriction, hypertrophy, fibrosis and apoptosis. END RESULT OF GROWTH AND REMODELING!


Main Ang II Functions

Vasoconstriction, Activate SNS, Elevate aldosterone


Differences between ACE-I's?

Half-Life and Potency


Pro-drug ACE-I

Enalapril (oral) to enalaprilat (IV only). (cleaves ethyl group)


Combinational Therapy Vasodilator Treatment? Population?

BiDil- Isosorbide dinitrate (ISDN) and hydralazine (HDZ). Used in african american population.


1st Gen Beta-Blocker

Nonselective! (block Beta 1 and 2 receptors)


Dominant Beta receptor of the heart? of the vasculature and pulmonary system?

Heart- B1
Vasculature and pulmonary- B2


2nd Gen Beta-Blocker

Selective blockade of β1- or β2-AR
Metoprolol, atenolol, betaxolol (all β1-AR selective)


3rd Gen Beta-Blocker

Selective or nonselective β-blockade plus ancillary property which produces a favorable pharmacological effect
Carvedilol (α-AR blockade, anti-oxidant properties, guanine-nucleotide modulatable binding, “tight” receptor binding)


Two Beta Blockers for Treating Heart Failure

Metoprolol (Toprol-XL) and Carvedilol (Coreg). Both have extended release, QD tablets


Length of time before B-Blockers begin to work?

On average, 3 to 6 months but can be as long as 6 to 9 months. Also, a portion of patients never are able to reach sufficient doses during titration.