Other drugs that are sometimes used to treat CHF include:
Brain natriuretic peptide (BNP) is a small peptide produced in the left ventricle and is released when the left ventricle experiences dilation or increased pressure. When BNP is released into the bloodstream, it causes the blood pressure to drop and reduces the strain on the heart, thus causing salts and water to be excreted by the kidneys.
Scientists have been able to make BNP in the lab, and now patients can be treated with BNP as a method of treating CHF. The new medication is called nesiritide (brand name Natrecor).
It is chemically identical to a naturally occurring peptide that the heart produces to try to relieve the symptoms of heart failure. Natrecor is used to rapidly reduce the elevated pressures within the heart and to improve shortness of breath.
Use of Natrecor has been associated with side effects, such as low blood pressure, dizziness, and lightheadedness. If any of these symptoms occurs, please alert your health care provider immediately.
Tumor Necrosis Factor–Alpha (TNF-α) is a protein produced in the body and has an important role in the functioning of the immune system. TNF-α works to increase inflammation and fight infection. When re-leased into the bloodstream, TNF-α can reduce the contractility of heart muscles and lead to dilation of the heart chambers (called cardiac remodeling).
Heart enlargement, in this setting, is associated with poor outcomes. High levels of TNF-α are found after heart damage. Studies have demonstrated that the risk of death in heart failure patients increases with higher levels of TNF-α.Tumor necrosis factor may play an etiologic role in idiopathic-dilated cardiomyopathy.
For these reasons, inhibition of TNF-α appears to be a valid target for the improvement of heart failure. Pentoxifylline suppresses TNF-α production and reportedly produces beneficial effects. Pentoxifylline is sold under the brand name Trental. Infliximab is a medication that binds to TNF-α and blocks its function.
It is highly effective in treating other diseases that are mediated by TNF-α, such as rheumatoid arthritis. However, in preliminary studies, it has not been shown to improve CHF outcomes. Infliximab is currently not recommended for the treatment of CHF and may result in worsening of CHF symptoms in some patients.
Erythropoietin is a drug that stimulates the production of red blood cells. When a person is anemic (that is, they have fewer red blood cells than they should), the heart has to work harder to get enough oxygen to the tissues. Anemia can contribute to or worsen symptoms of CHF.
Patients with severe, poorly controlled CHF and mild anemia might benefit from erythropoietin and supplemental iron to raise their blood level. Thiamine deficiency is caused by the chronic use of high-dose loop diuretics. Patients can achieve an improved ejection fraction by taking supplemental thiamine.