Heart Failure

Question 1

What are the doses for beta-blockers in heart failure?

Answer 1

Question 2

What are the drugs to prescribe for reduced ejection fraction heart failure as a GP?

Answer 2

Avoid fluid overload - Loop diuretic i.e furosemide

ACE-inhibitor

B-blocker

Note: only start ACE-inhibitor and B-blocker one at a time, otherwise risk hypotension!

Titrate to maximum tolerable dose if possible

Question 3

What are the drugs to prescribe for someone with reduced ejection fraction heart failure?

Answer 3

Avoid fluid overload - furosemide 20mg

ACE + B-blocker (start one at a time at lowest possible dose before titrating up)

Question 4

What are some symptoms in end-stage heart failure?

Answer 4

Pain

Breathlessness

Persistent cough

Fatigue

Limitation of physical activity

Depression and anxiety

Constipation

Loss of appetite and nausea

Oedema

Insomnia

Cognitive impairment

Question 5

Management for patients with end-stage heart failure?

Answer 5

Breathlessness - opioid, a benzodiazepine, and/or home oxygen

Pain - morphine/nitrates

Manage anxiety and depression

Manage constipation

Manage insomnia - i.e Z-drugs

Question 6

What to give for preserved ejection fraction heart failure?

Answer 6

Loop diuretic i.e furosemide