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Diuretics (drugs which increase urine output), morphine and oxygen are often used to treat patients who have to come to emergency ward with acute heart failure. But what are newer drugs useful for management of patients with acute heart failure? I am looking for names of such agents, each with a one line summary of their current status for this indication. Thanks for your responses.

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  • There's a host of them...do you want to narrow it down a bit? Commented Oct 2, 2015 at 8:48
  • I just want their names and a one line summary of current status for each of them.
    – rncardio
    Commented Oct 2, 2015 at 10:16

2 Answers 2

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I checked myself and found following agents are useful:

  • diuretics (for example frusemide, torsemide): to reduce fluid accumulation in lungs and other parts of body. Other agents such as thiazide and metolazone may be added if response is not adequate.
  • morphine: reduces anxiety, distress and diverts blood away from lungs by dilating peripheral blood vessels, especially veins.
  • oxygen: should be given only if hypoxia is there; otherwise it can cause vasoconstriction and may be deleterious.
  • vasodiators: e.g. nitroglycerin (or isosorbide dinitrate), nitroprusside, nesiritide. Used if blood pressure is not low.
  • inotropes: e.g. dobutamine, milrinone, levosimendan. Used if blood pressure is low.
  • vasopressors: e.g. dopamine, norepinephrine: only if blood pressure is low and not responding to inotropes.
  • low molecular weight heparin e.g. enoxaparin: to reduce risk of deep vein thrombosis

As patient stabilizes, agents known to be useful in long term treatment of chronic heart failure are added:

  • ACE (angiotensin converting enzyme) inhibitors (e.g. enalapril, ramipril) or ARBs (angiotensin receptor blockers) (e.g. losartan, telmisartan)
  • Aldosterone antagonist: e.g. spironolactone, eplerenone
  • Beta-blockers
  • Digoxin: especially useful if patients with atrial fibrillation
  • Ivabradine: useful in a subset of patients with chronic heart failure.
  • Valsartan/sacubitril combination: recently approved; shown to have better response than ACE-inhibitors in a large study.

These agents have been shown to provide survival benefit in long term to patients with heart failure.

References:

ACCF/AHA practice guidelines: http://circ.ahajournals.org/content/128/16/e240.extract

ESC guidelines: http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure

NICE guidelines: https://www.nice.org.uk/guidance/cg108

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Acetazolamide , a carbonic anhydrase inhibitor diuretic that reduces proximal tubular sodium reabsorption , is not a new drug , but has never been used for decompensated heart failure , however , new studies , the main : advor trial , have shown that it can improve the efficiency of diuretics . loop, potentially leading to faster and greater decongestion in patients with volume overload decompensated acute heart failure.

Reference

Mullens W, Dauw J, Martens P, et al., on behalf of the ADVOR Study Group. Acetazolamide in Acute Decompensated Heart Failure With Volume Overload. N Engl J Med 2022;Aug 2

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