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Drugs Used In the Treatment of Congestive Heart Failure
Prototype drugs to know for treatment of heart failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
DEFINITION “ The situation when the heart is  incapable of maintaining a cardiac  output adequate to accommodate metabolic requirements and the  venous return. " E. Braunwald
 
 
EVOLUTION OF  CLINICAL STAGES NORMAL Asymptomatic  LV Dysfunction Compensated CHF Decompensated CHF No symptoms Normal exercise Normal LV fxn No symptoms Normal exercise Abnormal LV fxn No symptoms Exercise Abnormal LV fxn Symptoms Exercise Abnormal LV fxn Refractory CHF Symptoms not controlled  with treatment Chronic Congestive Heart Failure
 
 
 
 
 
 
 
 
 
 
 
 
DIGOXIN   NEUROHORMONAL   EFFECTS   Plasma   Noradrenaline   Peripheral nervous system activity   RAAS activity    Vagal   tone Normalizes arterial baroreceptors
 
 
DIGOXIN TOXICITY CARDIAC MANIFESTATIONS ARRHYTHMIAS : -  Ventricular (PVCs, VT, VF) -  Supraventricular (PACs, SVT) BLOCKS: -  S-A and A-V blocks CHF EXACERBATION
 
 
% WORSENING  OF CHF p = 0.001 DIGOXIN: 0.125 - 0.5 mg /d  (0.7 - 2.0 ng/ml) EF < 35% Class I-III (digoxin+diuretic+ACEI) Also significantly decreased exercise time and LVEF. DIGOXIN  EFFECT ON CHF PROGRESSION RADIANCE N Engl J Med 1993;329:1 Placebo  n=93 DIGOXIN  Withdrawal DIGOXIN  n=85 30 10 0 20 100 80 20 0 40 60 Days
Placebo n=3403 DIGOXIN n=3397 48 0 12 24 36 OVERALL MORTALITY  % DIG N Engl J Med 1997;336:525 Months p = 0.8 50 40 30 20 10 0
 

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Digitalis Lecture

  • 1. Drugs Used In the Treatment of Congestive Heart Failure
  • 2.
  • 3.  
  • 4.  
  • 5. DEFINITION “ The situation when the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic requirements and the venous return. &quot; E. Braunwald
  • 6.  
  • 7.  
  • 8. EVOLUTION OF CLINICAL STAGES NORMAL Asymptomatic LV Dysfunction Compensated CHF Decompensated CHF No symptoms Normal exercise Normal LV fxn No symptoms Normal exercise Abnormal LV fxn No symptoms Exercise Abnormal LV fxn Symptoms Exercise Abnormal LV fxn Refractory CHF Symptoms not controlled with treatment Chronic Congestive Heart Failure
  • 9.  
  • 10.  
  • 11.  
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 16.  
  • 17.  
  • 18.  
  • 19.  
  • 20.  
  • 21. DIGOXIN NEUROHORMONAL EFFECTS Plasma Noradrenaline Peripheral nervous system activity RAAS activity Vagal tone Normalizes arterial baroreceptors
  • 22.  
  • 23.  
  • 24. DIGOXIN TOXICITY CARDIAC MANIFESTATIONS ARRHYTHMIAS : - Ventricular (PVCs, VT, VF) - Supraventricular (PACs, SVT) BLOCKS: - S-A and A-V blocks CHF EXACERBATION
  • 25.  
  • 26.  
  • 27. % WORSENING OF CHF p = 0.001 DIGOXIN: 0.125 - 0.5 mg /d (0.7 - 2.0 ng/ml) EF < 35% Class I-III (digoxin+diuretic+ACEI) Also significantly decreased exercise time and LVEF. DIGOXIN EFFECT ON CHF PROGRESSION RADIANCE N Engl J Med 1993;329:1 Placebo n=93 DIGOXIN Withdrawal DIGOXIN n=85 30 10 0 20 100 80 20 0 40 60 Days
  • 28. Placebo n=3403 DIGOXIN n=3397 48 0 12 24 36 OVERALL MORTALITY % DIG N Engl J Med 1997;336:525 Months p = 0.8 50 40 30 20 10 0
  • 29.