(B-BLOCKERS) & Heart Failure?

[القصرعينية]

is it wise to give B-blockers to patient with heart failure?
what do u think?

:smiley25:

[walaa]

from pharmacological view ,, i think that B-blockers are contraindicated in patients with heart failure as it has the following effects on the hearte:
1/-ve inotropic , -ve chronotropic , -ve dromotropic .
2/-- excitability & automaticity.
3/-- COP & cardiac work .
4/V.C due to unopposed alpha receptors leads to initial ++ in P.R .
و الله أعلم ..

[القصرعينية]

very happy to have u back n forum WALAA:smiley20: :smiley20: :smiley20:
elmontada nawar

SO N.B.:
Heart failure is a progressive disorder in which damage to the heart causes weakening of the cardiovascular system. It is clinically manifested by fluid congestion or inadequate blood flow to tissues. Heart failure progresses by inappropriate responses of the body to heart injury.

Also to be more clear, we have:
1.Acute heart failure.
2.Chronic heart failure.

The blockade of beta-1 adrenoreceptors is negatively chronotropic and inotropic, and delays conduction through the AV node. If beta-2 receptors are blocked then this leads to coronary and peripheral vasoconstriction.

SO WHAT DO U THINK?

[nabilprofelgen]

حمد الله على http://www.elkasrelaini.com/english/students/forum/images/smilies/smiley1.gifhttp://www.elkasrelaini.com/english/students/forum/images/smilies/smiley1.gifhttp://www.elkasrelaini.com/english/students/forum/images/smilies/smiley1.gifالسلامة ياولاء
بخصوص البيتا بلوكر
كان زمان موش بيتم استخدامها فى الهارت فالير
بس دلوقتى بيتم استخدامها
و هبعت التفسير كمان يومين
بس مايو كلينيك بتقول اذا الدكتور مكتبش للعيان بيتا بلوكر بسبب واضح
العيان يسيبه و يروح لدكتور تانى و يرفع على الدكتور الاولانى قضية

و بأذن الله هبعت التفسير كمان يومين

و يجعله عامر

[walaa]

منور بيكم يا قصر عينية ...
الله يسلمك يا نبيل ,, هو انا كنت مسافرة ؟؟؟؟
:smiley2: :smiley2:
بالراحة عليا شوية ,, انا لسه بقول يا هادي ,, يعني حبيت أتفلسف شوية تعملوا في كدة ,, على العموم أنا قلت المعلومة اللي بيقولوهلنا من أول السنة و بعدين الكلية مليانة تناقضات يعني يوقوا كلام و السنة اللي بعدها يقولوا غيره ,,, على العموم انتوا كده شجعتوني اني ابحث في الموضوع و لو عرفت حاجة جديدة هقولكم ...
و في انتظار التفسير يا نبيل ...

[Mohamed_kadi]

"my idea is not so clear about this."
But i remember i was so confused in the matter of using b-blockers in ttt of h. f. when i was studying pharmacology.
then, i didn't search or ask about this. (u know, we're not asked to be interested in thinking!!!!)
my idea was that using B-blockers have no value in ttt of the cause of failure but their value is in modifying or correcting the body compensatory reactions that occures in responce to failure of heart 2 deliver adequate blood supply.
as this mechanisms may lead 2 more failure!!
in heart failure, heart rate is increased as a compensatory reaction to failure but this increase worsen the case (to some extent).
so, selective B1-blockers reduce the rate & make the case more stable.
the same thing about the contractility of the heart.
B-blockers that act on alph receptors (i think; i mean on bl. vessels) will also improve the case by lowering blood pressure including the diastolic one..which is a load against heart contractility.
i mean that the matter is 2 compensate btw adiquate blood supply & not to leave the heart muscle 2 be exhausted & fails more & more.
am i true??
but then, my question is that do we use them in compination with digitalis? & how?

[القصرعينية]

B-blockers that act on alph receptors (i think; i mean on bl. vessels) will also improve the case by lowering blood pressure including the diastolic one..which is a load against heart contractility.
How comes that B-blocker act on alpha receptor?!

One of the compensatory mechanisms of the heart in HF is the redistribution of blood, through sympathetic stimulation which acts on the BV of the whole body. Since the predominant receptors in BV of the heart & brain are B- receptors thus VD is the result, while the predominant receptors in rest of blood vessels is alpha so VC occurs leading to shift of blood from the body to the most important organs (heart & brain).
The receptors in BV of the heart are B2- receptors.
So it is unwise to block B2-receptors.

On the contrary, blockade of beta-1 adrenoreceptors is negatively chronotropic and inotropic, and delays conduction through the AV node -as we said before, BUT it blocks the effects of norepinephrine, which are +ve chronotrpic & +ve inotropic increasing the work on the heart.

So it is beneficial to use selective B1- blockers.

The question now is :
r they used in both acute & chronic heart failure?

WHAT DO U THINK?

[Mohamed_kadi]

sorry...
i ment "B-blockers that act on alph receptors as well"
i'm really not positive, but i can remember that there are a group of non-selective B-blockers acts on Beta & Alpha1. one of them named somthing like this Labetlol

this group is what i mean....u got it??

sorry again that i have no accurate inf. even my books of pharmacology are not with me now. & i have no time 2 search about this now.
but i'm very interested in this topic. so i did share...

i have more 2 ask but just tell me i am not causing u 2 get confused.

[القصرعينية]

have more 2 ask but just tell me i am not causing u 2 get confused
"Dr.Mohamed_kadi" U don't know how much i am really happy:tamtam: that lastly i had this discussion in the forum, it is really important to me & i hope all the medical threads have the same appreciation & response. Also i wish that anyone find something that he/she doesn't understand it, write here in forum & let us discuss it. It is really useful:smiley20: ..by the way this is how this topic came, i dicussed this point with a friend & we didn't clearly understand the point so this thread was written..see?..
so don't feel
sorry... ok?

Back to the topic:


non-selective B-blockers acts on Beta & Alpha(labetalol)
alpha 1 receptors are responsible for the peripheral VC helping the mechanism redistribution of blood flow - previously mentioned- so i think it is unwise to block them otherwise pooling of blood occurs & thus decreased blood to heart & brain.
so back to the previous question:


r they used in both acute & chronic heart failure?

WHAT DO U THINK?

[فيرون]

http://sprojects.mmi.mcgill.ca/heart/bb990515R3.html

[nabilprofelgen]

thanks to Kasrainia for :
BUT it blocks the effects of norepinephrine, which are +ve chronotrpic & +ve inotropic increasing the work on the heart.So it is beneficial to use selective B1- blockers.

plus i will add in smallllllllllllll dooooooooosssssssssssssse.

this is the most reasonalble cause walaaa.
in my opinion, this room in the forum deserves to be the room of 2004 in educational section.

good luck.

[walaa]

Exactly that is what i know when i ask one of my pharma professors ,,, but i think that combined therapy of both SELECTIVE B1-blocker $ DIGITALIS will be more effective as it ++ mechanical efficiency $ COP and -- HR ,,,,, what do you think???????????
thank you all .........

[القصرعينية]

ß-blockade should now be regarded as part of standard therapy in chronic heart failure.


regard combined digitalis & B-blockers.. i think it is advisable as walaa said..


in my opinion, this room in the forum deserves to be the room of 2004 in educational section.


i hope it becomes so in all years..

[Eman Samir]

i really liked this discussion so much, & i think as Mohamed said, we need 2 learn how 2 think.

thanx Kasr

[HAMED378]

Assalomu alaikom , freinds

I was so happy about your enriching discussion,that made this discussion board so different than the past,really it was a great happening that gives the hope for every one looking for the complete change and replacement(that's too far to be dreamed about).In this way,i can give the point of view of my information resources about that if it is wise to give B-blockers to patient with heart failure or not .



For years, evidence has been accumulating that beta blockers are useful drugs in patients with heart failure due to dilated cardiomyopathy.in the past (not so much),doctors were taught that it's that you don’t use beta blockers in patients with heart failure. Consequently, tens of thousands of patients with heart failure are being treated inappropriately .



acoording to the COPERNICUS trial,Approximately 2200 patients with severe heart failure were enrolled in this trial. They all received optimal medical therapy with ACE inhibitors, diuretics, and digitalis. They were then randomly assigned to receive either carvedilol or placebo. The resulting analysis showed a 35% improvement in survival among patients receiving carvedilol. The improvement in survival was even greater in patients with particularly severe heart failure.



Furthermore, patients receiving the beta blocker had no more side effects than those receiving the inactive placebo.



The results of the COPERNICUS trial are in line with other recent studies examining the use of beta blockers in patients with heart failure. Trials using bisoprolol and metoprolol showed similar results.


VERY SOON
,God willing , i'll send you about how this comes ,how can beta blockers benifit a heart failure patient

[القصرعينية]

hope to have many topics with same reaction of people

[adham173]

what u r diong doctors here called (ta7shesh) coz when u need infos u shouldn't have to talk it from (taleb3'alban zayak) so u have to search on text or ask a prof. thank you

[مصباح]

beta-Blocker therapy in heart failure: scientific review.

Foody JM (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Foody+JM%22%5BAuthor%5D), Farrell MH (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Farrell+MH%22%5BAuthor%5D), Krumholz HM (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Krumholz+HM%22%5BAuthor%5D).

Yale University School of Medicine, New Haven, CT 06520-8025, USA.

CONTEXT: Care of patients with heart failure has been revolutionized throughout the past decade. A paradigm shift in the strategy for treating heart failure caused by systolic dysfunction is in progress. Despite the initial perception about beta-blockers' safety, they are now the most extensively studied class of agents in the treatment of heart failure and have emerged as an important intervention to improve the clinical outcomes of heart failure patients.

OBJECTIVE: To provide scientific rationale for the use of beta-blockers for patients with heart failure.

DATA SOURCES: All English-language articles of large, randomized controlled clinical trials assessing the mortality benefits of beta-blockers in patients with heart failure were identified to provide the scientific rationale for the use of beta-blockers in heart failure. Basic science studies were reviewed to provide an overview of the potential physiologic role of beta-blockers in heart failure. Finally, clinical guidelines for the treatment of patients with heart failure were assessed to determine current recommendations for the use of these agents.

STUDY SELECTION AND DATA EXTRACTION: Randomized controlled clinical trials of beta-blockers that included more than 300 subjects and assessed mortality as a primary end point.

DATA SYNTHESIS: Of the 4 beta-blockers tested in large randomized controlled clinical trials of patients with heart failure, 3 are available in the United States, bisoprolol, carvedilol, and metoprolol; 2 of these, carvedilol and metoprolol, have Food and Drug Administration indications for the treatment of heart failure. Compared with placebo treatment, beta-blocker use is associated with a consistent 30% reduction in mortality and a 40% reduction in hospitalizations in patients with class II and III heart failure.

CONCLUSIONS: Tested in more than 10,000 patients, beta-blockers reduce morbidity and mortality in class II through IV heart failure. Along with angiotensin-converting enzyme inhibitors, digoxin, and diuretics, beta-blockers have strengthened the armamentarium to improve clinical outcomes of heart failure patients. The science supporting beta-blockers must be translated into practice safely and rationally if the agents are to achieve their full potential.

Publication Types:

Review (javascript:AL_get(this, 'ptyp', 'Review');)

PMID: 11851582 [PubMed - indexed for MEDLINE]

see full text: (available for free if you're interested)
http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--highwire.stanford.edu-icons-externalservices-pubmed-free-jama-free.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?PrId=3051&uid=11851582&db=pubmed&url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11851582)