- So in the early stages of heart failure,
remember that treatments were more targeted
at the risk factors for heart failure
and this is usually before the symptoms
of heart failure even come about
to try and slow or stop these symptoms from ever appearing.
But in the later stages, when the symptoms associated
with heart failure have already started to crop up,
there's going to be a different set of medications
that we might try and use
that are aimed at treating and controlling these symptoms
that have already started to affect
the patient's quality of life.
And two of the main symptoms we're going to target
are congestion, or fluid build up, and fatigue.
So the first type that we look at are diuretics
and these medications help treat the symptoms of congestion.
But how do they do that?
Well, they help the body get rid of excess fluid
and this can have several effects,
one of which is to reduce the symptoms
that result from fluid buildup, right,
that makes sense.
Like shortness of breath from fluid in the lungs.
And the second is that with less fluid,
your blood volume also decreases, right?
And so there's less blood in your blood vessels.
When there's more blood in the blood vessels,
they actually have to stretch more
and this causes this higher pressure
and so when you reduce this amount,
one of the effects is actually a reduction in blood pressure
and this can potentially help keep heart failure
from getting worse in the future.
And so one of the primary types of diuretics used
are aldosterone inhibitors.
And from this name, we can see that these
are probably going to inhibit
aldosterone in some form, right?
But what's aldosterone?
Well in short, it's this super important hormone
that causes our body to retain sodium
and when we retain sodium, we also retain fluid.
So if aldosterone causes us to retain sodium and fluid,
we'd expect aldosterone inhibitors
to have the opposite effect
and that's exactly what it does.
It helps remove excess fluid.
So aldosterone inhibitors act as a diuretic
that help reduce fluid buildup and therefore,
reduce the symptoms associated with fluid buildup.
And the second type of medication
that might be prescribed are calcium channel blockers.
These, however are reserved
for treating diastolic heart failture
where your heart has trouble filling with enough blood.
Again, the name is going to be
pretty self-explanatory, right?
These must block the channels for calcium.
And the entry of calcium through these channels
plays an important role as a messenger
that tells certain muscle cells
that it's time to contract.
And one of these types of muscles
is the smooth muscle around your arteries
and so if this channel is blocked
and this muscle isn't getting the signals to contract,
that means they aren't as constricted
so one of the effects is to dilate your arteries
and this lowers the arterial blood pressure
and makes it easier for your heart to pump blood out.
And a second type of muscle that it affects
is your heart muscle and when these contract,
you get a heartbeat, right?
So blocking these channels tend
to make the heart contract less
therefore lowering your heart rate
and lowering your heart rate gives it more time
to fill with blood and allows more blood to be pumped out,
which is a big part of diastolic heart failure.
And so if you're pumping more blood out,
that means your body's receiving more blood
so you might not feel as fatigued as you did before.
Finally, the last type of medication
that's not as often used anymore
but sometimes for select patients
is digoxin and it has two main effects.
So the first effect is that it can increase the strength
of your muscle contractions in your heart
so it makes the heart pump harder
and then it tends to slow down the heart rate
so sometimes, it's used for patients
that have uncontrollably fast heart rates
and it just kind of brings it down to a reasonable level.
And so in addition to these just listed,
the ACE inhibitors and the Beta Blockers
described in the early stages video may also still be used
to control blood pressure in the later stages.