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Heart Failure Drugs: Inotropic Agents

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...

Heart Failure Drugs: β-Blockers

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...

Heart Failure II: Pathophysiology

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...

Heart Failure VI: Adjunct Therapies

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.

Heart Failure V: Medical Management

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...

Heart Failure III: Clinical Manifestations

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...

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Related Experiment Video

Updated: Oct 15, 2025

Viral Transgene Expression in Rodent Hearts and the Assessment of Cardiac Arrhythmia Risk

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Published on: July 27, 2022

Vagal stimulation in heart failure.

Veronica Dusi¹, Gaetano Maria De Ferrari²

¹Division of Cardiology, Department of Medical Sciences, Citta della Salute e della Scienza Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy. veronica.dusi@unito.it.

|October 30, 2021

Summary

Vagal nerve stimulation (VNS) shows promise for heart failure, but large trials were inconclusive. Further research is exploring optimal VNS dosing and patient selection for improved outcomes.

Keywords:

Autonomic imbalance Autonomic regulation therapy Device therapy Neuromodulation Sympathetic nervous system

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Area of Science:

Cardiology
Neuroscience
Biomedical Engineering

Background:

Vagal nerve stimulation (VNS) has a strong theoretical basis for treating heart failure with reduced ejection fraction.
Preclinical and pilot studies suggested VNS efficacy, but large trials (NECTAR-HF, INOVATE-HF) did not confirm these benefits.

Purpose of the Study:

To re-evaluate the potential of VNS in heart failure by addressing limitations in previous trial designs and understanding of VNS parameters.
To investigate the complex dose-response relationship of VNS, including pulse amplitude, frequency, duration, and duty cycle.

Main Methods:

Review of previous VNS trials in heart failure.
Analysis of accumulated knowledge on VNS pathophysiology and optimal parameter settings.
Initiation of a new randomized study with an adaptive design and refined patient selection.

Main Results:

Previous large-scale VNS trials in heart failure did not meet primary endpoints, suggesting suboptimal application or patient selection.
Understanding of VNS dose-response complexities has advanced since initial trials.

Conclusions:

The failure of earlier trials may stem from insufficient understanding of VNS pathophysiology and optimal delivery parameters.
A new randomized study aims to optimize VNS therapy for heart failure with reduced ejection fraction through adaptive design and targeted patient selection.