Let's talk about direct vasodilators.
Nitrates like nitroprusside and nitroglycerin are often used.
And nesiritide is a new drug that is a natriuretic peptide.
It causes vasodilation and volume reduction at the same time.
We give it as an IV infusion in acute heart failure only.
So, they are not used in chronic heart failure patients.
Other direct vasodilators include hydralazine
and isosorbide dinitrate.
You can use both in combination. They do reduce
mortality in African American patients in a major study
that was released in the United States some years ago.
Calcium channel blockers are also sometimes used,
but not in heart failure. These are more angina type medications.
Remember that the dihydropyridine and the non-dihydropyridine
drugs differ in that one works on the heart and one doesn't.
There is no use in reducing inotropy,
so that's not particularly helpful.
Peripheral vasodilation can help in terms of calcium channel
blockers, but it also causes a reflex tachycardia,
so we don't use it as much in heart failure.
Loop diuretics are a mainstay in heart failure treatment.
I won't go into too much detail about diuretics as a whole
because I've discussed them in detail
in the hypertension lecture.
But to make a long story short,
furosemide is probably used the most in acute heart failure,
and it can also be used,
and easily titrated in chronic heart failure too.
If a patient is allergic to furosemide,
we sometimes use ethacrynic acid.
Other diuretics include the thiazide diuretics
like hydrochlorothiazide and indampamide.
Indampamide, by some measures, are better tolerated.
Amongst the thiazide diuretics, indampamide or chlorthalidone
to hydrochlorothiazide for hypertension.
Chlorthalidone is the preferred thiazide
diuretic for hypertension
due to prolonged half-life and proven reduction of
cardiovascular disease risk.
Potassium-sparing diuretics are also used
Amiloride, spironolactone, and triamterene.
Once again, I covered these medications in the
But these are really good to reduce afterload and
to reduce hypervolemia.