Vasodilators – Angina and Heart Failure Management

00:01 Let's talk about direct vasodilators. Nitrates like nitroprusside and nitroglycerin are often used.

00:08 And nesiritide is a new drug that is a natriuretic peptide. It causes vasodilation and volume reduction at the same time.

00:15 We give it as an IV infusion in acute heart failure only. So, they are not used in chronic heart failure patients.

00:24 Other direct vasodilators include hydralazine and isosorbide dinitrate.

00:29 You can use one or 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.

00:41 Calcium channel blockers are also sometimes used, but not in heart failure. These are more angina type medications.

00:48 Remember that the dihydropyridine and the non-dihydropyridine drugs differ in that one works on the heart and one doesn't.

00:57 There is no use in reducing inotropy, so that's not particularly helpful.

01:01 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.

01:16 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.

01:27 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.

01:38 If a patient is allergic to furosemide, we sometimes use ethacrynic acid.

01:45 Other diuretics include the thiazide diuretics like hydrochlorothiazide and indampamide.

01:51 Indampamide, by some measures, are better tolerated. I personally haven't seen a huge difference between the two.

01:58 Metolazone is another diuretic agent that is given in acute situations.

02:05 I discussed this in our hypertension lecture. Go to the hypertension lecture and have a look at the heart failure cocktail that I mentioned there.

02:15 Potassium sparing diuretics are also used as well. Amiloride, spironolactone, and triamterene.

02:23 Once again, I covered these medications in the hypertension lecture.

02:26 But these are very good to reduce afterload and to reduce hypervolemia.