6. Heart failure

Question 1

Heart failure causes

Answer 1

common causes
- hypertension
- coronary artery disease

Question 1

Heart failure symptoms

Answer 1

• Oedema - swollen ankles and legs
• Frothy blood spained sputum (oedema in lungs), cough
• Fatigue and low exercise tolerance
• Dyspnoea

Question 2

Types of heart failure

Answer 2

ejection fraction - how well left ventricle pumps blood out to the rest of the body

Reduced ejection fraction: < 40%

Preserved ejection fraction: >50%

Question 3

Heart failure treatment - reduced ejection fraction

Answer 3

Fluid overload: Loop OR thiazide diuretic

1st line treatment:
ACE inhibitor AND beta blocker

• If ACE inhibitor intolerant, consider ARB:
  valsartan, candesartan, losartan
• Beta-blockers used:
  Bisoprolol, carvedilol, nebivolol (70+ mild-moderate heart failure)

If symptoms continue:
ADD aldosterone antagonist

If symptoms STILL continue:
SPECIALIST ADVICE + sacubitril, valsartan, ivabradine, hydralazine + nitrate, digoxin

ACE inhibitors/ARB’s, beta-blockers used should be licensed for heart fa

Question 4

Heart failure treatment -
preserved ejection fraction

Answer 4

Managed by specialists