Heart Failure

Question 1

Symptoms of heart failure

Answer 1

• Dyspnoea (SOB)
• Exercise intolerance / fatigue
• Oedema

Question 2

What are the two types of Oedema

Answer 2

1) Pulmonary oedema = breathlessness

2) Peripheral oedema = swollen ankles / legs.

Question 3

Treatment options of Heart failure (first / second / third)

Answer 3

First line 
-	Ace / ARB + Beta blocker 
Second line 
-	Aldosterone antagonist - Spironolactone 
Third line 
-	Speak to heart failure consultant and consider these drugs 
-	Anti-arythmicdrugs 
o	Digoxin 
o	Amiodarone

Question 4

Second line treatment of patients with heart failure or with worsening symptoms

Answer 4

Aldosterone antagonist (Spironolactone)

Question 5

Third line option in patient with heart failure

Answer 5

Speak to heart consultant and consider anti-athymic drugs such as Digoxin and Amiodarone.

Question 6

In patients with fluid overload due to heart failure which medication should be considered – which ones are the diuretic of choice

Answer 6

Thiazide diuretic

Loop diuretic

Question 7

What factors do you have to consider when prescribing thiazide diuretics for patients.

Answer 7

EGFR <30 ml/min thiazide diuretic are contraindicated

Question 8

Which medication would you not give to patients who have heart failure and why. What is the exceptions

Answer 8

Rate limiting CCB and short acting dihydropyridines, because they reduce the ejection fraction. The exception is amlodipine.