CHAPTER 2: CVS: Heart Failure Flashcards
Drug treatment is for heart failure with reduced what?
Left ventricular ejection fraction
If ejection fraction is preserved, is drug treatment still indicated for heart failure?
No
What are the aims of heart failure treatment? (4)
- Reduce mortality
- Improve exercise tolerance
- Relive symptoms
- Reduce exacerbations
What is the first line treatment for heart failure with reduced ejection fraction?
ACE inhibitor + Beta blocker
Which drug is licensed for mild to moderate heart failure in patients over 70?
Nebivolol
Heart failure treatment should be started by those with experience, how should the drugs be initiated?
At a low dose then slowly titrated up
Which drugs can be used under specialist supervision as adjuncts to ACE inhibitors?
Candesartan or Valsartan
What is step 2 of heart failure with reduced ejection fraction treatment?
ACE inhibitor + Beta blocker + Spironolactone
What is an alternative to spironolactone?
Eplerenone
What must be monitored with spironolactone?
- Creatinine
- eGFR
- Potassium
What is an alternatives to ACE inhibitors and ARBs?
Isosorbide dinitrate with hydralazine
Can isosorbide dinitrate with hydralazine be added to the ACE inhibitor and beta blocker in patients who remain symptomatic?
Yes, particularly black people with moderate-severe heart failure
What are the benefits of using digoxin in heart failure? (3)
- Improves exercise tolerance
- Improves symptoms of heart failure
- Reduces exacerbations and hospitalisations
In which patients is digoxin reserved for?
Worsening or severe heart failure due to left ventricular dysfunction
What should patients with fluid overload also receive?
Diuretic - loop or thiazide
