Q; Why nonsteroidal antiinflammatory drug (NЅΑІD) is not recommended in heart failure patients?
Answer: Patients with advanced heart failure tend to have high circulating vasoconstrictors as a natural response to preserve hemodynamics. In response to these vasoconstrictors, the kidney increases its secretion of vasodilator prostaglandins to preserve kidney perfusion and lower systemic vascular resistance. NЅΑІDs decreases prostaglandin synthesis and subsequently causes renal ischemia, which in turn raises serum creatinine.
The overall effect is a further fall in cardiac output due to increased afterload. This risk can be exacerbated in diabetic patients.
#cardiology
#pathophysiology
References:
1. Dzau VJ, Packer M, Lilly LS, et al. Prostaglandins in severe congestive heart failure. Relation to activation of the renin--angiotensin system and hyponatremia. N Engl J Med 1984; 310:347.
2. Minhas D, Nidhaan A, Husni ME. Recommendations for the Use of Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Disease Risk: Decades Later, Any New Lessons Learned? Rheum Dis Clin North Am. 2023 Feb;49(1):179-191. doi: 10.1016/j.rdc.2022.08.006. PMID: 36424024.
3. Holt A, Strange JE, Nouhravesh N, Nielsen SK, Malik ME, Schjerning AM, Køber L, Torp-Pedersen C, Gislason GH, McGettigan P, Schou M, Lamberts M. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023 Apr 18;81(15):1459-1470. doi: 10.1016/j.jacc.2023.02.027. PMID: 37045515.
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