Which of the following is not used in hea failure?
(A) Metoprolol (B) Trimetazidine (C) Sacubitril (D) Nesiritide
(B) Beta blockers in hea failure -Beta blockers are contraindicated in acute hea failure but they can be used in chronic hea failure. At first beta blockers should be staed at low dose, dose should be increased gradually so that predominant action is on kidneys not on hea. Beta blockers used are - Carvedilol, metoprolol and bisoprolol. Sacubitril - It is NEP(neutral endopeptidase) inhibitor, which is required for metabolism of BNP(brain natriuretic peptide) as a result BNP levels are increased resulting in natriuresis and vasodilation. Thus can be used in CHF. Nesiritide- It is recombinant BNP. It is given through subcutaneous route. Trimetazidine -it is a metabolic modulator. it paially inhibits beta oxidation of fatty acids which results in shifting of metabolism of hea muscles from fatty acids to glucose Which require less amount of oxygen so beneficial for the patient of angina pectoris but not used in hea failure.