Pharmacotherapy of heart failure

Heart failure (HF) is one of the major problems related to heart diseases in the modern era. Multiple comorbidities such as coronary artery disease, hypertension, diabetes mellitus, and anemia have a great contribution in the development of HF. It is primarily two types systolic and diastolic HF. Insufficient or decreased pumping of the heart is systolic HF, whereas diastolic HF is because of lack of ability of the heart to relax or increased muscle inflexibility. The pathophysiology of HF is due to enhanced activity of sympathetic system, renin angiotensin system, and structural changes in the wall of ventricle. The two definite targets of medical treatment in HF are as follows: (1) Alleviation of obstructive (or) decreased output manifestations and replenishment of cardiac function. The drugs used are frusemide, thiazides, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), amrinone/milrinone, dopamine/dobutamine, levosimendan, digoxin, hydralazine, nitroprusside, nitrate, bisoprolol, metoprolol, nebivolol, and carvedilol. (2) Prevention of advancement of HF and extension of patient survival-drugs used are β blockers, ACE inhibitors/ARBs, spironolactone, and eplerenone.