Heart failure –

Left heart failure is a condition that decreases the emptying of the LV.

As a result, the blood from left atrium cannot enter freely into the LV.

Pressure in LV & LA is higher than expected during relaxation (Diastole).

Backpressure is transmitted backwards into the lung because the LA is unable to accept delivery of blood coming from the lung and so on.

Eventually it affects the RV and then the RA.

Poor pumping leads to poor renal perfusion. Kidneys thus increase pressure via Renin-angiotensin-aldosterone cycle.

Mortality risk reduction is 30-40% with beta-blockers.

60% of deaths in CHF patients are sudden.

Risk in this is most reduced by beta blockers

With heart failure, blood pressure gets less, sympathomimetics increase, and these cause myocardionecrosis. Beta-blockers stop this and preserve function.

ACE inhibitors reduce volume overload on heart by acting on the Renin angiotensin aldo system. They are also very useful in improving ventricular remodeling when after an MI there is ventricular dysfunction.

Spironolactone is a helpful diuretic in those who are SOB at rest.

Hydralazine combined with nitrates have improved mortality.

Carvedilol (Coreg)- combined alfa and beta blocker has been most effective in reducing mortality and improving cardiac function.