Use of Ramipril and Carvedilol Combination Therapy in Heart Failure

Topics: Myocardial infarction, ACE inhibitor, Hypertension Pages: 24 (2401 words) Published: December 26, 2013
Assignment:

Treatment

of

Heart

Failure:

The severity of HF is determined by The New York

Carvedilol and Ramipril

Heart Association classification (NYHA), which is

Keywords: Heart failure, beta-blockers, carvedilol,

summarized in the table 15.

angiotensin-converting enzyme inhibitors, ramipril.
INTRODUCTION
Heart failure (HF) is the disease of the elderly. Over
70% of the patients are older than 65 years. The risk
of having the condition rises with age. HF can be
defined as a clinical syndrome. The ability of the
heart to pump blood is impaired and it can no
longer meet the body’s metabolic requirements

Table 1. New York Heart Association Classification of Heart
Failure. Remme WJ, Swedberg K. Guidelines for the diagnosis
and treatment of chronic heart failure. European Heart Journal. [Online] 2001; 22(17): 1527-1560.

during the rest or exercise1. By treating HF we try
to relieve patients symptoms, improve their quality
of life, prevent hospitalization and most importantly
prolong their life. The treatment includes improved
diet (reduced salt intake), physical activity and
pharmacological treatment. There are numerous
classes of drugs on the market such as digitalis,
angiotensin-receptor blockers (ARBs), vasodilators,
angiotensin-converting enzyme (ACE) inhibitors
(Ramipril) and beta-blockers (Carvedilol). We will
have a look at the last two classes. They have been

PATHOPHYSIOLOGY
The previous hemodynamic model was not
adequate

and

was

therefore

replaced

by

neurohormonal model, which involves Reninangiotensin-aldosterone-system sympathetic

nervous

system1,

(RAAS)
3

.

RAAS

and
is

summarized in Figure 1. The activation of RAAS
leads to vasoconstriction, oedema and myocardial
fibrosis, which are induced by Angiotensin II1.

proven to be very efficient in HF by numerous
clinical studies2-4.
SYMPTOMS AND SIGNS
HF involves many symptoms such as dyspnoea
(rest or exercise), paroxystic nocturnal dyspnoea,
fatigue, and ankle oedema.1 The signs of HF are
tachycardia

(>100

beats

per

minute),

tachyarrhythmia, tachypnoea, distended jugular
murmur and S3 and S4 heart sounds. The

Figure 1. pathophysiology of heart failure and different levels of therapeutic intervention. Taken from: Perrenoud JJ. Heart
failure (Part 1). European Geriatric Medicine. [Online] 2011; 2(3): 159-171.

occurrence of these symptoms and signs depends on

One of the earliest neurohormonal changes in HF is

the severity of heart failure and whether it is caused

sympathetic activation and it has a primary role in

vein, peripheral oedema, hepatomegaly, heart

1,4

by systolic dysfunction or diastolic dysfunction .

disease progression. Left ventricular remodeling,
cell death and changes in gene expression are

believed to be the main mechanisms that induce

ejection fraction8-11. Because it is very potent, small

myocardial

doses of the tablet should be taken at the start of

damage

induced

by

sympathetic

nervous stimulation10.

treatment (3.125mg) twice daily. The dose is

Heart failure can be categorized in predominantly

gradually increased up to maximum of 50mg twice

systolic dysfunction where the emptying of the left

daily8.

ventricle is not optimal and predominantly diastolic
dysfunction where the filling of the left ventricle is

Molecular targets

not optimal1-6.

As mentioned above, its major molecular targets are
membrane receptors (ß1, ß2 and α1). It acts on ion

TREATMENT

channels (Ca2+ and K+) as well. Carvedilol inhibits

As mentioned above, the disease can be treated

cardiac voltage-dependent potassium IKr channels

using several different drug classes4. Multidrug

with high potency, voltage-dependent calcium

therapy is widely used in patients with heart failure.

channels as well as Ca2+-permeable transient

Many different clinical trials...
Continue Reading

Please join StudyMode to read the full document

You May Also Find These Documents Helpful

  • Essay about Heart Failure
  • Essay about Congestive Heart Failure
  • Essay on Heart Failure Tutorial
  • heart failure Essay
  • Heart Failure Essay
  • Heart Failure Essay
  • Essay about Congestive Heart Failure
  • Managing Heart Failure Essay

Become a StudyMode Member

Sign Up - It's Free