Therapy for heart failure

Medication

Inhibition of neurohumoral autoregulation (maladaptation)

In patients with heart failure, the body “mistakenly” retains water and salt due to the activation of various autoregulation systems – this leads to edema (water retention) in the body and other undesirable reactions. A large part of the drug therapy for heart failure is based on the inhibition of these systems.

Beta blockers inhibit the so-called sympathetic nervous system activity and contribute to a reduction in energy consumption by reducing the heart rate, among other things.

Angiotensin converting enzyme (ACE) inhibitors, angiontensin receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA) inhibit the so-called renin-angiotensin-aldosterone system (RAAS). The so-called RAAS blockade prevents, among other things, excessive salt and water retention and an increase in peripheral vascular resistance. The associated dilation of the blood vessels leads to a reduction in the so-called load against which the heart has to beat. The combination preparation of the angiotensin receptor neprilysin inhibitor (ARNI) developed in recent years can be used instead of ACE inhibitors or angiotensin receptor blockers and also prevents the breakdown of so-called natriuretic peptides, which, in addition to other beneficial effects, have a positive influence on the salt and water balance.

The so-called SGLT2 inhibitors are also the result of recent developments. These drugs were originally developed for the treatment of diabetes mellitus, but show beneficial effects in patients with heart failure. In addition to their favorable influence on the water balance (through the elimination of glucose and salt), it is likely that other effects, which are the subject of current research, contribute to their positive effect in patients with heart failure.

Diuretics are diuretic drugs that are primarily used to maintain a normal water balance and thus prevent the accumulation of water in the lungs or legs. As water retention is mainly responsible for the typical symptoms of heart failure such as shortness of breath and oedema, diuretics make a significant contribution to alleviating the symptoms of heart failure.

Technical devices / Devices

Cardiac resynchronization therapy (CRT) is used in the form of specialized pacemakers which, under certain conditions, can correct a cardiac action that is no longer synchronous. The consequence of this therapy is the restoration of a more energetically efficient pumping action of the heart.

Internal cardioverter defibrillators (ICD) are implantable defibrillators that continuously monitor the heart rhythm and, in the event of dangerous cardiac arrhythmias, can terminate them by electrical stimulation or by delivering an electrical shock.

Telemedicine in heart failure

Most of these implantable high-tech devices contain integrated monitoring systems. These systems can use various sensors to signal an impending deterioration in heart failure at an early stage and inform the treatment team via telemedicine, so that unnecessary hospitalizations can be avoided.

In addition to integrated monitoring systems, there are stand-alone miniaturized pressure sensors that can be implanted in the pulmonary artery and measure pulmonary arterial pressure directly. This data can then also be transmitted to the treatment team via telemedicine and the drug therapy can be adjusted accordingly, which can also avoid unnecessary hospitalizations.

Treatment team