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1.           SGLT2 Inhibitors (e.g.empagliflozin, dapagliflozin) are now recommended for all HF patients, including HF with preserved ejection fraction. These drugs reduce mortality and hospitalizations, and stabilize renal function. Side effects include hypovolemia, UTIs, rarely euvolemic DKA and Fournier’s gangrene.

2.           Finerenone is a nonsteroidal mineralocorticoid receptor antagonist used primarily for chronic kidney disease. It is demonstrating increasing cardiovascular benefits in HF. Important side effects include hyperkalemia, hyponatremia and hypotension (like spironolactone).

 

3.           GLP-1 Agonists (e.g semaglutide) have an expanding role in HF. These drugs have shown benefits in improving symptoms, increasing exercise capacity, and lowering cardiovascular events (particularly HFPEF). Common side effects are GI related and uncommonly pancreatitis, cholecystitis.

 

4.           Cardiac myosin inhibitors (mavacamten, aficamten), are used to treat symptomatic obstructive hypertrophic cardiomyopathy. These drugs reduce cardiac contractility and LVOT gradients, improving dyspnea, chest pain. Side effects include reduced LVEF (usually reversible), HF and presyncope.

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5.           Transthyretin Amyloid Cardiomyopathy causes HF (often preserved ejection fraction), arrhythmias (atrial fibrillation), and symptoms (e.g. fatigue, low output). Median survival without treatment is ~3 years. New emerging drugs include tafamidis, acoramidis. These stabilize transthyretin, reducing hospitalizations and mortality.  Generally, they are well-tolerated with rare issues related to liver enzyme elevations and renal impairment. Patients may present with worsening CHF symptoms, often due to disease progression rather than drug effects.