Heart Failure

Question 1

Whats heart failure

Answer 1

Structural or functional abnormalities of the heart resulting in reduced cardiac output

Not enough blood pumped out the heart

Question 2

Whats the difference between acute and chronic HF

Answer 2

Chronic- progressed overtime

Acute- sudden symptoms, emergency admission to hospital

Chronic HF can develop into acute HF

Question 3

Symptoms of HF

Answer 3

Ankle swelling
persistent cough and wheezing
SOB
Chest pain (in angina)
Palpitations (in arrhythmias)
Pulmonary oedema

Question 4

Whats the most common cause of HF

Answer 4

coronary heart disease

Hypertension
Heart valve disease
Arrhythmias
Hypo/hyperthyroidism
Severe anaemia

Question 5

How is HF diagnosed

Answer 5

Blood test : NT-proBNP increases in HF

ECG, urine, signs of fluid retention such as crackles in lungs, oedema

Question 6

Lifestyle Management of heart failure

Answer 6

Lifestyle - restrict salt in diet <6g daily recommended

Patient should weigh themselves daily and report weight gain
- 1.5-2.0kg in 2 days - report to GP

Question 7

When are loop diuretics used in HF

Answer 7

Liquid in lungs present - pulmonary oedema

Question 8

Whats the 1st line in HF

Answer 8

Acei/ARB and BB

Question 9

A patient with angina is diagnosed with HF what do you give 1st line

Answer 9

BB followed by acei/arb

Question 10

An african carribbean is diagnosed with HF what do you give

Answer 10

Hydralazine and nitrate instead of ACEI/ARB as they dont tolerate them

Question 11

Whats the 2nd line in HF

Answer 11

MRA

Question 12

If 2nd line is ineffective in HF add

Answer 12

Refer to specialist

Question 13

If MRA is added and symptoms persist youd ______

Answer 13

Refer to specialist they can add sacubitril or valsartan instead of ACEi/ARB

Or add digoxin, ivabradine

Question 14

A patient is diagnosed with HF. They also have AF. What do you give and at what dose

Answer 14

Digoxin 125mcg daily

Question 15

What class of drugs shouldnt be given in HF, unless its ____

Answer 15

CCB

amlodipine

Question 16

Can BB be used in HF

Answer 16

Only in stable HF

Question 17

Drugs used in HF

Answer 17

BANDAIDS

BB - only in stable HF
Acei/Arb
Nitrates and Hydralazine
Diuretics (loop/ MRA/thiazide)

Amiodarone
Ivabridine
Digoxin
Sacubitril/ valsartan

Question 18

Can empagliozin and dapagliflozin be used in HF

What strength

Answer 18

Yes
10mg OD as ADD ON therapy, not alone

Question 19

What ARBs are used in HF

Answer 19

Candersartan
Losartan
Valsartan

Question 20

A patient is diagnosed with HF but also has angina and COPD. What do you give

Answer 20

Start with BB +acei after due to angina
Even though BB should be avoided in COPD, diabetes, ED they should be used in HF as benefits outweigh the risk

Question 21

A patient is diagnosed with angina and HF. What class of drugs should be avoided

Answer 21

CCB cant be used in HF unless its amlodipine

Question 22

When are loops used in HF

Answer 22

To relieve breathlessness and oedema in patients with fluid retention

Question 23

When are thiazides used in HF

What does the eGFR need to be for you to be able to use them

Answer 23

In patients with mild fluid retention and eGFR >30

Question 24

When can mineral corticoid antagonists not be used in HF

Answer 24

If the patient has hyperkalaemia or renal impairment

Question 25

What vaccine is offered in HF

Answer 25

Annual influenza vaccine
pneumococcal disease

Question 26

Can NSAIDs be used in HF

Answer 26

No it worsens it. Stop

Question 27

When are ACEi started first

Answer 27

If they also have fluid overload or diabetes

Question 28

When would you prescribe ARBs in HF

Answer 28

In those unable to take ACEi due e.g., dry cough