Chronic Heart Failure Management

Question 1

1st line for chronic heart failure?

Answer 1

ACEi + beta-blocker

Question 2

Beta-blockers used for heart failure?

Answer 2

Bisoprolol, carvedilol, nebivolol

Question 3

2nd line for chronic heart failure?

Answer 3

Aldosterone antagonist - spironolactone, eplerenone
If reduced ejection fraction - SGLT-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin)

Question 4

3rd line for chronic heart failure?

Answer 4

HR >75 + left ventricular fraction <35 = IVABRADINE
Left ventricular fraction <35 + symptomatic on ACEi/ARB = sacubitril/valsartan
Digoxin (esp if AF present)
Afro-Caribbean = HYDRALAZINE + NITRATE
Widened QRS = cardiac resync

Question 5

Vaccines for chronic heart failure?

Answer 5

Annual influenza vaccine
One-off pneumococcal vaccine (every 5 years if spleen or kidneys fucked)

Question 6

Initial 2 stages of chronic heart failure management?

Answer 6

Offer diuretics for congestive sx/fluid retention
Establish if ejection fraction preserved or reduced (drug treatment if reduced, conservative if preserved)