Drugs Used in Congestive Cardiac Failure

Congestive cardiac failure (CCF), commonly referred to as heart failure, is a clinical condition in which the heart is unable to pump sufficient blood to meet the body's metabolic requirements. Reduced cardiac output activates compensatory mechanisms such as the sympathetic nervous system and renin–angiotensin–aldosterone system (RAAS). Although initially helpful, persistent activation increases cardiac workload, fluid retention and ventricular remodeling, thereby worsening heart failure.

The main goals of drug therapy are to relieve symptoms, reduce fluid overload, decrease cardiac workload, prevent disease progression and improve survival. The choice of drugs depends on the type and severity of heart failure.

Important drugs used in heart failure include diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor–neprilysin inhibitors (ARNI), β-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors and cardiac glycosides. Diuretics such as furosemide reduce oedema and pulmonary congestion. ACE inhibitors, ARBs and ARNIt reduces the harmful effects of the RAAS. Evidence-based β-blockers help control excessive sympathetic stimulation and reduce adverse cardiac remodelling. Spironolactone and eplerenone block aldosterone and provide important benefits in selected patients.

Digoxin is a cardiac glycoside that increases myocardial contractility by inhibiting Na⁺/K⁺-ATPase. In acute or severe decompensated heart failure, selected patients may require intravenous positive inotropic drugs such as dobutamine or milrinone.

For competitive examinations, special attention should be given to the mechanism of action, important adverse effects, electrolyte disturbances, drug interactions and distinctive features of each class.

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