Heart failure therapy

Drugs

Inhibition of neurohumoral autoregulation (maladaptation).

In patients with heart failure, the body “mistakenly” retains water and salt due to activation of various autoregulatory systems – resulting in edema (water retention) in the body and other adverse reactions. Much of the drug therapy for heart failure is based on drug inhibition of these systems.

Beta-blockers inhibit what is known as sympathetic activity and contribute to a reduction in energy expenditure by reducing 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 resulting dilation of the blood vessels leads to a reduction in the so-called load against which the heart must beat. The combination preparation of angiotensin receptor-neprilysin inhibitor (ARNI), which has been 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 salt and water balance.

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

Diuretics are diuretic drugs that are primarily used to maintain normal water balance and thus prevent water accumulation in the lungs or legs. Since water retention is the main cause of the typical symptoms of heart failure, such as shortness of breath and edema, diuretics play an important role in alleviating the symptoms of heart failure.

Technical devices / Devices

The so-called cardiac resynchronization therapy (CRT) is used in the form of specialized pacemakers, which under certain conditions can correct a heart 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 through electrical stimulation or the delivery of an electrical shock.

Telemedicine in heart failure

Most of these implantable high-tech devices include 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, where they directly measure the so-called pulmonary arterial pressure. This data can also be transmitted to the treatment team via telemedicine and the drug therapy can be adjusted accordingly, thus also avoiding unnecessary hospitalizations.