Role of Nitrates and Nesiritide in the Management of Heart Failure

In this article, we will discuss the Role of Nitrates and Nesiritide in the Management of Heart Failure. So, let’s get started.

Nitrates

Intravenous nitroglycerine or sodium nitroprusside are primarily used for acute or severely decompensated chronic heart failure especially associated with hypertension or myocardial ischemia. The starting dose of nitroglycerin is 10 μg/min titrated upwards to 10-20 μg/min infusion to achieve desired effect. The dose of nitroprusside is 0.3-0.5 μg/kg/min with upwards titration to maximum of 10 μg/kg/min.

Oral nitrate or nitrate transdermal patches are effective in long-term management.

Nesiritide

This agent, a recombinant form of human BNP is a potent vasodilator, improves cardiac output. Its hemodynamic effects resemble those of I.V. nitroglycerine. The ASCEND trial has found it useful in improving symptoms of CHF. In clinical studies, nesiritide (administered as 2μg/ kg I.V. bolus injection followed by an infusion of 0.01 μg/kg/min which may be titrated upwards) produced rapid improvement in dyspnea hemodynamic parameters.

The role of nesiritide may be primarily in patients who continue to be symptomatic after treatment with diuretics and nitrates.

Recombinant human relaxin 2 or serelaxin is being tried in acute decompensated heart failure. It reduces dyspnea and symptoms and signs of congestion.

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