Table 1. Pharmacologic agents, Putative effects and usefulness in management of heart failure with reduced ejection fraction.
| Pharmacologic Agents | Putative Effects | Usefulness |
|---|---|---|
| Angiotensin Converting Enzyme Inhibitors | Inhibits the conversion of angiotensin I to angiotensin II | Inhibits the systemic effects of chronic RAAS activation. Improves survival |
| Angiotensin-receptor blockers | Inhibits the effect of angiotensin II on type 1 angiotensin (AT-1) receptors | Inhibits the systemic effects of chronic RAAS activation. Improves survival |
| Beta-blockers | Inhibits the adrenergic receptors | Inhibits the systemic effects of chronic SNS activation. Control of heart rate. Improves survival |
| Mineralocorticoid receptor antagonists | Inhibits the effect of mineralocorticoids on its receptors | Inhibits the systemic effects of chronic RAAS activation. Improves survival |
| Hydralazine with isosorbide dintrate (ISDN) | Vasodilators. Reduces both preload and afterload | Control of systemic blood pressure. Improves survival |
| Angiotensin receptor-neprilysin inhibitor (ARNI) | Natriuresis, vasodilation, and anti-proliferative effects | Control of systemic blood pressure. Improves survival |
| Ivabradine | Inhibits the pacemaker current (If) in the sinoatrial node | Control of heart rate. Improves morbidity (HF hospitalization) |
| Diuretics | Blocks the Na+/K+/Cl- transporter in the loop of Henle and the Na+/Cl- co-transporter in the distal convoluted tubule of the kidney | Diuresis and optimizing volume status. Improves symptoms in acute decompensated HF |
| Digoxin | Inhibits the Na+/K+ ATPase in myocardial cells resulting in the increased intracellular Ca2+ | Increases cardiac muscle contractility (mild positive inotropic effect) |
| Dobutamine | Stimulates B1, B2 and A1 receptors leading to conversion of adenosine triphosphate to cyclic adenosine monophosphate (cAMP) by adenyl cyclase resulting in the increased intracellular Ca2+ | Increases cardiac muscle contractility (Positive inotropic effect) |
| Milrinone | Inhibits phosphodiesterase-3 leading to increased cAMP levels and thus increased intracellular calcium | Increases cardiac muscle contractility (Positive inotropic effect) |
RAAS indicates renin angiotensin aldosterone system; SNS – sympathetic nervous system; HF – heart failure.