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Common Congenital Heart Lesions - page 91 / 126

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91 / 126

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  • C.

    Inotrophic Drugs

    • Mechanism of action: increase intracellular Ca, increasing force of contraction, decreases end-diastolic volume and increases SV and CO

    • Used to treat systolic ventricular dysfunction (not diastolic dysfxn)

    • Beta agonists (dobutamine and dopamine): limited use because only IV form and drug resistance common

    • Digitalis: IV or oral, increases contractility and improves symptoms, also decreases sympathetic drive, reducing afterload. Good for patients with heart failure and concurrent atrial fib because it treats arrhythmias too. Treats symptoms, but does NOT improve survival.

  • D.

    Beta Blockers

    • Mechanism of action: unclear, but have been shown to decrease HR, increase CO and improve survival

    • Use with caution to prevent decreased contractility

  • E.

    Spironolactone

    • Mechanism of action: aldosterone antagonist, K-sparing diuretic

    • Aldosterone contributes to fibrosis and remodeling of the heart, spironolactone counteracts

    • Increases survival and relieves symptoms

    • Must monitor to ensure hyperkalemia does not develop

  • F.

    Summary of Drug Therapy for chronic congestive heart failure

Left Ventricular Systolic dysfunction: ACE inhibitor + beta blocker

  • +

    congestion (pulm or systemic): add diuretic

    • +

      volume overload/ clinical deterioration: subtract beta blocker

    • +

      persistent symptoms: add digoxin

    • +

      advanced heart failure: add spironolactone

If can’t tolerate ACEI: ARB or H-ISDN Other drugs to consider: anticoagulants and anti-arrhythmics (getting back to sinus rhythm increases CO)

Diastolic dysfunction: treat underlying cause! Then, use diuretics to decrease edema and pulmonary congestion, being careful not to substantially decrease end-diastolic pressure, use Ca channel blockers when diastolic dysfunction caused by HTN or hypertrophic cardiomyopathy

G. Other therapies for chronic heart failure: resynchronization of the ventricles using a pacemaker (indicated when ventricles do not contract

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