Pharmacology: Drugs for Heart Failure, Animation

Mechanisms of actions of ACE inhibitors, Angiotensin receptor blockers (ARBs), Beta-blockers, Aldosterone receptor antagonists (ARAs), Digoxin, Ivabradine, Angiotensin Receptor-Neprilysin Inhibitor, ARNIs (sacubitril/valsartan), Diuretics, Vasodilators. Role of RAAS, sympathetic system and natriuretic peptide system in pathophysiology of Congestive heart failure (CHF) and rational for treatment of HF.
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Voice by : Marty Henne
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Heart failure is when the heart is unable to pump effectively, called systolic heart failure; or unable to fill properly, called diastolic heart failure. In both cases, blood output is reduced. Ejection fraction is reduced in systolic heart failure, but typically preserved in diastolic heart failure.
The pathophysiology of heart failure involves a vicious cycle in which reduced cardiac output, as a compensatory response, activates the renin-angiotensin-aldosterone system (RAAS) and sympathetic system. However, these systems cause vasoconstriction, increase heart rate and blood pressure, making it even harder for the heart to pump. Increased aldosterone level also promotes ventricular remodeling, myocardial scarring, and vascular injury, worsening the disease.
On the other hand, the natriuretic peptide system is also activated. This system is protective to the heart. It promotes vasodilation, sodium and water excretion, and inhibits cardiac remodeling.
Most drugs used in heart failure therapy aim to inhibit RAAS and sympathetic activities, and/or promote the natriuretic system. Other drugs increase ventricular contractility or reduce water retention - a major heart failure symptom.
First-line therapy for patients with reduced ejection fraction typically includes an angiotensin-converting enzyme (ACE) inhibitor, and a beta-blocker.
- ACE inhibitors block the conversion of angiotensin-I to angiotensin-II in RAAS, thereby inhibiting RAAS activity. Common side effects include dry cough, headache, and hypotension. Rarely, ACE inhibitors may cause a swelling reaction known as angioedema.
- Angiotensin receptor blockers (ARBs) inhibit the effects of angiotensin-II. Their mechanism of action is similar to that of ACE inhibitors, but they do not usually cause a cough.
- Beta-blockers decrease heart rate by binding to β1-adrenergic receptor in the heart and blocking the sympathetic influences that act through these receptors. Adverse effects: hypotension, bradycardia and AV blocks.
- Vasodilators reduce blood pressure and are usually used for patients who cannot tolerate ACE inhibitors or ARBs.
- Diuretics are often prescribed to relieve fluid retention. Loop diuretics are most powerful and typically used for most patients. Thiazides are less effective, but they also have a vasodilation effect, and are thus preferred for patients with hypertension but only mild fluid retention.
- Aldosterone receptor antagonists block the action of aldosterone. Because aldosterone’s primary function is to promote sodium and water retention, and potassium excretion; aldosterone antagonists act as potassium-sparing diuretics. However, their effect in heart failure treatment is also attributed to the inhibition of aldosterone’s damaging impact on the heart and blood vessels.
- Digoxin increases cardiac contractility by inhibiting the sodium-potassium pump, causing intracellular sodium concentration to rise. This then leads to higher levels of intracellular calcium via the action of sodium-calcium exchanger. Higher calcium results in increased muscle contraction. Digoxin also decreases sympathetic activities, slowing down heart rate.
- Ivabradine slows the heart rate by inhibiting the “funny” channel responsible for spontaneous firing of the SA node. Adverse effects include bradycardia, atrial fibrillation, and vision problems.
- ARNIs are a new class of medications. ARNI therapy consists of a neprilysin inhibitor and an ARB.

[@Alilamedicalmedia]

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[@satyanarayanatamvada4934]

One day lecture is not enough to discuss cardiac issues, but you made it lucid in 6 min ! . Worthy synopsis.

[@slubuggy123]

What a video! Too good, no book has explained management of CHF as concisely and effectively as this video!

[@samuelchinda-sb9zw]

I'm a cardiovascular pharmacologist, video is explicitly instructive and concise.

[@waelfadlallah8939]

This short video is a major proof that you channel is the best of what it do. The way you organize these info in a brief period of time is amazing and finally glad to learn about the new class of medication (ARNI) :).

[@Alilamedicalmedia]

Thanks very much :)

[@GENERALTIM21]

@@Alilamedicalmedia any chance you can move the copyright overlay for each of your videos to somewhere less invasive? It can often occlude diagrams/information

[@dr.rozinahoque5107]

Very helpful video, I'm a doctor, .... It made my concept much clearer!! ❤thanks a ton!!

[@Bill.R.124]

excellent. I've never even heard of the last two classes and I've been in critical care for many, many years

[@patgallagher5167]

Thank you for this channel. What a great summary of drugs

[@bobcarney2186]

A good snapshot of the chf world. Throw in individual side effects and anomalies, other ailments like trying diuretics on patients with gout, and the roulette wheel is in a full spin.

[@Drsandipandebbarma]

So good so good , just now I studied heart failure management from book and I was little confused but after seeing this the concept is clear now...thank you sir .. 😊❤❤❤

[@Alilamedicalmedia]

Wonderful! 😀

[@MauiXoXo]

Alila should win the BEST in Teaching Award. 🎉❤❤

[@Alilamedicalmedia]

Thanks 😊

[@tasneem202]

خير الكلام ما قلّ ودل !🤍

[@jackiehanley6274]

When we cant belive the answer ❤❤❤❤god bless America and get well America 🎗🎗🎗🎗🎗🇺🇲🇺🇲🇺🇲

[@hawong5379]

Excellent presentation to explain the complex concepts behind the heart failure medication . Thanks so much for your outstanding video 👍🏼👍🏼👍🏼

[@erinflorencesebastian8105]

I love your videos so much!! So concise and well-explained

[@michaelawuni4286]

Great video.very helpful

[@jeweljose9631]

Amazing video! Short and crisp but contained everything significant...thank you so much 🙏❤️

[@chebiiben4360]

The best video ever

[@sabsab1701]

That was greattt❤

[@user-rk2fm3bn3u]

Thank you ❤ Very nice ❤

[@amosmoses7081]

I am Amos Zor Moses I am also suffering from heart failure, I want you to please help me send me the listing of medications that will help me to treat this decease.

[@jibymathew9485]

amazing video

[@tsiontemesgen4205]

How is a beta blocker given to a heart failure ?, specially in systolic heart failure.... the beta blocker will slow down the heart rate and reduce its contractility and in heart failure the contractility of the heart muscle has already been reduced

[@user-cv7sr9qo5c]

Because in HF there is activation for sympathetic sys. due to reduced blood to peripheral tissue so can increase HR and contractility , so its benifecial to use beta blocker in this case.

[@elham7383]

The major problem in HF is that it doesn’t pump enough blood. So the thing that I didn’t get it is why we give them beta blockers that reduce the heart rate ?

[@afnanmo5779]

My professor said that for this fact it worsens the symptoms short term ( which is why you don't give it if the patient is decompensated and in an acute phase ) but long term it actually improves the contractility and overall morbidity and mortality

[@tasneem202]

Sympathetic system overall increase the heart rate, and when the heart is already failure (can't contract effectively) in this case i don't need anything increases HR because this would make things worse, i need making my heart comfortable since it's tired, moderate HR is enough for it, so that's why i give them beta blockers

[@thecoffeebrewingmedic9748]

When HR reduces the diastole time increases, it’s during the diastolic phase the coronary vessels gets blood flow to them which essentially ensures cardiac perfusion.

[@tysonmunyoro8901]

HF due to high BP take note

[@tysonmunyoro8901]

If the heart contract fast ventricular feeling won't be enough hence less ejection fraction

[@TundeEszlari]

Super video.

[@salo7328]

Nice

[@cardiologistheart7000]

perfect!!

[@indiraghai7972]

Diuretics in heart failure

[@renus6694]

What is the role of selective alpha blockers like prazosin , in reduced HF patients? Which category will it belong in above video

[@Alilamedicalmedia]

It reduces sympathetic vasoconstriction => vasodilation

[@RobdeKlerk-qg6lc]

​@@Alilamedicalmediametoprolol or amlodipine an option doctor..?

[@LawfirmEO]

1:36

[@indiraghai7972]

RAAS

[@indiraghai7972]

Ivabradine cause atrial fibrillation

[@indiraghai7972]

Digoxin contractile

[@indiraghai7972]

Natriuretic neorilysn

[@indiraghai7972]

Eplerenone

[@manoharshenoy4800]

Every medication has side effects. So, try only natural ways to improve heart function.

[@FONK6969]

Don't give poor advice. Many need it.

[@ApollosNjogu]

Like?

[@keshavaraodasari9721]

Please do not propagate unknown facts. Heart doesn't pump blood. The question blood pressure is not as per text book range which totally wring

[@Alilamedicalmedia]

Wow, good luck! I feel really sorry for you!

[@hawong5379]

Yea, if the heart is not the organ to pump blood, then which is the right organ in the body to pump and circulate the blood ? 😂😂😂

[@markasbell4200]

Girl, what? 😂

[@ruhisamani4502]

Your text doesnt make sense! what are you trying to say?

[@FONK6969]

😂😂😂

[@badralaouikobbi3422]

Thank you for this amazing video, there is also 2 new drugs such as Dapaglifozin/Empaglifozin ir Vericiguat.

[@ANISHASHEE-xv5wr]

The video should have mentioned Calcium channel blockers (CCBs) like Verapamil, Nifedipine, Diltiazem . Because CCB always works 🫰