Definition
Heart failure is a disease in which the heart muscle, and therefore the heart, does not have sufficient strength to pump the blood necessary to meet the body's metabolic needs.
Heart failure generally appears as a progressive disease that gradually worsens over time. In some cases, however, the disease can also present itself in an acute form.
Causes
The triggering causes of heart failure can be different. However, it often happens that the disease 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 diseases, myocarditis, arrhythmias, thrombosis or atherosclerosis with aortic stenosis and other cardiovascular diseases.
In addition, heart failure can also be caused by alcohol abuse, allergic reactions, heart infections, or other types of diseases, such as, for example, anemia, diabetes, hypothyroidism or "hyperthyroidism and systemic lupus erythematosus.
Symptoms
The first symptoms that appear in case of heart failure are rather nonspecific and consist of dyspnoea, fatigue and peripheral edema. In the more advanced phase, however, specific symptoms may appear, such as orthopnea and jugular congestion.
Other symptoms that may occur in patients with heart failure are respiratory acidosis, adynamia, anasarca, cardiac arrhythmias, hepatic congestion, extrasystoles, atrial or ventricular fibrillation, hyperkalaemia, hyperventilation, hyponatremia, hypoxia, wheezing, somnolence, confusion, cough, tachypnea and pleural effusion.
The 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.
Medicines
Treatment of heart failure involves drug therapy and some lifestyle changes in patients. Individuals with heart failure, in fact, have to stay at rest and have to 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.
Furthermore, in some cases, the doctor may deem it necessary to resort to surgical treatment.
The following are the classes of drugs most used in therapy against heart failure and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment.
ACE inhibitors
ACE inhibitors perform their action by inhibiting the angiotensin converting enzyme (from English: Angiotensin Converting Enzyme, or ACE). They are vasodilators that work by reducing the workload of the heart. heart failure and in preventing the symptoms associated with it, thus improving the quality of life of patients who suffer from it.
- Enalapril (Enapren ®, Converten ®): The initial amount of enalapril usually used orally is 2.5 mg per day. Thereafter, the doctor will gradually increase the daily dose of the drug, until the most suitable dosage for each patient is reached. 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 per day. The exact amount of medication to be taken will be determined by the doctor.
- Ramipril (Triatec ®): The starting dose of ramipril usually used orally is 1.25-2.5 mg per day. Subsequently, the doctor may increase the amount of the drug to be taken, up to a maximum of 10 mg per 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 according to the patient's condition.
Sartani
The sartans who perform an "antagonistic action against the receptors of angiotensin II (a peptide hormone that promotes and stimulates vasoconstriction). They are, therefore, vasodilator drugs that act in a similar way to ACE inhibitors. In fact, sartans are often used in the treatment of heart failure in those patients who cannot tolerate ACE inhibitor treatment.
Sartans can be administered either alone or in combination with diuretics and / or beta-blockers.
- Losartan (Losapre ®, Neo-Lotan ®, Lastan ®, Lorista ®): The starting dose of losartan usually administered orally is 12.5 mg per day. Thereafter, the doctor will gradually increase the dose of medication until the optimal dosage is achieved for each patient.
- Valsartan (Tareg ®): The usual starting dose of valsartan is 40 mg, to be taken orally twice daily. Subsequently, the doctor will increase the dose of drug administered until the optimal dose for the patient is reached, taking care not to exceed the maximum amount 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 determined by the physician on an individual basis.
Beta blockers
Beta-blockers can be used in the treatment of heart failure as they reduce the symptoms it induces and improve heart function.
- Carvedilol (Dilatrend ®): When used in the treatment of heart failure, the starting dose of carvedilol usually given is 3.125 mg, to be taken twice daily orally. Thereafter, the doctor may decide to increase the amount of the drug to be taken. administer until the optimal dosage 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 cardiac contraction force.
When administered orally, the dose of digoxin usually used in adults and children over 10 years of age is 0.25-1.5 mg per day, taken as a single dose or in divided doses.
Diuretics
Diuretics are used in the therapy of heart failure to reduce edema caused by the disease itself. Among the various active ingredients that can be used, we remember:
- Hydrochlorothiazide (Esidrex ®): hydrochlorothiazide is a diuretic belonging to the class of thiazides. The dose of drug to be taken orally must 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 which inhibit carbonic anhydrase. The dose of drug usually used orally is 250-375 mg per day. However, the exact dosage of the medicinal product must be determined by the doctor.
- Furosemide (Lasix ®): the drug dose 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 hypokalaemia and / or with hyponatremia.
Aldosterone receptor antagonists
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, the antagonists of aldosterone receptors reduce the risk of hospitalization of patients and may favor a prolongation of the life. Among these drugs we remember spironolactone (Spirolang ®). In the treatment of heart failure, the dose of spironolactone usually administered orally is 100-200 mg per day, to be taken in divided doses.
