Congestive heart failure vasodilators: Difference between revisions

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| [[congestive heart failure resident survival guide|Resident <br> Survival   <br> Guide]]
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===Combination of Hydralazine and Nitrates in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] Circulation 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> ===
===Combination of Hydralazine and Nitrates in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] Circulation 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref> ===


{| class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The combination of fixed-dose of [[isosorbide dinitrate]] and [[hydralazine]] to a standard medical regimen for [[HF]], including [[ACE inhibitors]] and [[beta blockers]], is recommended in order to improve outcomes for patients self-described as African Americans, with [[NYHA]] functional class III or IV [[HF]] Others may benifit similarly, but this has not yet been tested.<ref name="pmid15533851">{{cite journal |author=Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN |title=Combination of isosorbide dinitrate and hydralazine in blacks with heart failure |journal=[[The New England Journal of Medicine]] |volume=351 |issue=20 |pages=2049–57 |year=2004 |month=November |pmid=15533851 |doi=10.1056/NEJMoa042934 |url=http://dx.doi.org/10.1056/NEJMoa042934 |accessdate=2012-04-05}}</ref><ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' The combination of fixed-dose of [[isosorbide dinitrate]] and [[hydralazine]] to a standard medical regimen for [[HF]], including [[ACE inhibitors]] and [[beta blockers]], is recommended in order to improve outcomes for patients self-described as African Americans, with [[NYHA]] functional class III or IV [[HF]] Others may benifit similarly, but this has not yet been tested.<ref name="pmid15533851">{{cite journal |author=Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN |title=Combination of isosorbide dinitrate and hydralazine in blacks with heart failure |journal=[[The New England Journal of Medicine]] |volume=351 |issue=20 |pages=2049–57 |year=2004 |month=November |pmid=15533851 |doi=10.1056/NEJMoa042934 |url=http://dx.doi.org/10.1056/NEJMoa042934 |accessdate=2012-04-05}}</ref><ref name="pmid10496190">{{cite journal |author=Carson P, Ziesche S, Johnson G, Cohn JN |title=Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group |journal=[[Journal of Cardiac Failure]] |volume=5 |issue=3 |pages=178–87 |year=1999 |month=September |pmid=10496190 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1071916499000196 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|}
|}


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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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Revision as of 20:06, 11 August 2013
Resident
Survival
Guide
File:Critical Pathways.gif

Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
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Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure vasodilators On the Web

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Directions to Hospitals Treating Congestive heart failure vasodilators

Risk calculators and risk factors for Congestive heart failure vasodilators

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Nitrates reduce both preload and afterload in the setting of congestive heart failure and thereby relieve symptoms.

Vasodialators

Background

  • A nitrate may be added to ACE inhibitors to relieve symptoms of pulmonary edema
  • The addition of a nitrate to an ACE inhibitor may improve exercised tolerance.
  • The combination of hydralazine and nitrates is useful in patients with advanced heart failure[1] and in particularly, when ACE inhibitors are not well tolerated.
  • Hydralazine by itself is only an arterial vasodilator and does not reduce left ventricular filling pressures to the same extent as nitrates and ACE inhibitors do. In fact when used alone it can stimulate sympathetic tone reflexively. The combination of hydralazine and nitrates has been shown to decrease mortality as well as improve the left ventricular ejection fraction and exercise capacity in patients with heart failure. However the combination of hydralazine and nitrates has been found to be less effective than ACE inhibitors.
  • The major of use of this combination is in those patients who are intolerant of ACE inhibitors.

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [2][3]

Combination of Hydralazine and Nitrates in Patients Presenting With Heart Failure (DO NOT EDIT) [2][3]

Class I
"1. The combination of fixed-dose of isosorbide dinitrate and hydralazine to a standard medical regimen for HF, including ACE inhibitors and beta blockers, is recommended in order to improve outcomes for patients self-described as African Americans, with NYHA functional class III or IV HF Others may benifit similarly, but this has not yet been tested.[1][4] (Level of Evidence: A) "
Class IIa
"1. The addition of a combination of hydralazine and a nitrate is reasonable for patients with reduced left ventricular ejection fraction (LVEF) who are already taking an ACE inhibitor and beta blocker for symptomatic heart failure and who have persistent symptoms.[4][5] (Level of Evidence: B) "
Class IIb
"1. A combination of hydralazine and a nitrate might be reasonable in patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency. [4][6][7] (Level of Evidence: C) "

Vote on and Suggest Revisions to the Current Guidelines

External Links

References

  1. ↑ 1.0 1.1 Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN (2004). "Combination of isosorbide dinitrate and hydralazine in blacks with heart failure". The New England Journal of Medicine. 351 (20): 2049–57. doi:10.1056/NEJMoa042934. PMID 15533851. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 2.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  3. ↑ 3.0 3.1 3.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  4. ↑ 4.0 4.1 4.2 Carson P, Ziesche S, Johnson G, Cohn JN (1999). "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group". Journal of Cardiac Failure. 5 (3): 178–87. PMID 10496190. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  5. ↑ Cohn JN (1993). "The Vasodilator-Heart Failure Trials (V-HeFT). Mechanistic data from the VA Cooperative Studies. Introduction". Circulation. 87 (6 Suppl): VI1–4. PMID 8500232. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  6. ↑ Cohn JN, Archibald DG, Ziesche S, Franciosa JA, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH (1986). "Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study". The New England Journal of Medicine. 314 (24): 1547–52. doi:10.1056/NEJM198606123142404. PMID 3520315. Retrieved 2012-04-05. Unknown parameter |month= ignored (help)
  7. ↑ Loeb HS, Johnson G, Henrick A, Smith R, Wilson J, Cremo R, Cohn JN (1993). "Effect of enalapril, hydralazine plus isosorbide dinitrate, and prazosin on hospitalization in patients with chronic congestive heart failure. The V-HeFT VA Cooperative Studies Group". Circulation. 87 (6 Suppl): VI78–87. PMID 8500244. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)


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