Heart Failure

Question 1

What are the symptoms of heart failure?

Answer 1

Dyspnoea during activity or rest
Exercise intolerance/fatigue
Oedema

Question 2

What is the first line treatment for heart failure?

Answer 2

1. ACEi/ARB + B-blocker

Candesartan
Nebivolol 
Valsartan
Bisoprolol
Carvedilol

Alternatively
Hydralazine + isosorbide dinitrate

Question 3

What is the second line treatment for heart failure?

Answer 3

ACEi/ARB + B blocker + spironolactone

Eplerenone if after acute MI or mild heart failure

Alternatives
Hydralazine + isosorbide dinitrate
ARB
Sacubitril valsartan (Left ventricular ejection fraction > 35%)

Question 4

What is the third line treatment for heart failure?

Answer 4

ACEi/ARB + B blocker + spironolactone + ivabradine or digoxin

Digoxin if severe or worsening heart failure
Ivabradine if patient in sinus rhyth, and heart rate > 75 bpm

Question 5

When do you add on loop diuretics in heart failure?

Answer 5

If there is fluid overload

Question 6

When do you add on thiazide diuretics in heart failure?

Answer 6

In mild heart failure and fluid overload