Heart Failure Flashcards
Symptoms of heart failure
Shortness of breath
Persistent coughing or wheezing,
Ankle swelling,
Reduced exercise tolerance
Fatigue
Non-drug treatment
Lifestyle changes
Smoking cessation
Reducing alcohol consumption
Weight loss
Reducing salt intake
Which antihypertensive should be avoided in heart failure patients with reduced ejection fraction? Why?
CCB (except amlodipine) as they can further depress cardiac function and exacerbate symptoms.
What is heart failure and angina treated with?
Amlodipine
Chronic heart failure treatment
ACE-I and beta blocker (ARB if ACE-I not tolerated)
Aldosterone antagonist
Amiodarone, digoxin, entresto, ivabradine, or dapagliflozin (usually dapa or entresto)
Loop diuretic
All titrated to max tolerated dose
When would digoxin be used in chronic heart failure?
Patients in sinus rhythm in worsening or severe heart failure
What treatment is used when ACE-I and beta blockers are not tolerated?
Hydralazine and nitrate under specialist
Digoxin HF loading dose
62.5 – 125 microgram OD
Monitoring requirements
ACE-I, ARBs, MRAs - baseline, 1-2 weeks after starting and at each dose increment, 3 monthly then every 6 months
- K and Na
- Cr
- BP
Beta blockers
- HR and BP
How to manage dosing in CKD heart failure patients
Lower doses and slower titration of ACE-I, ARB, MRA and digoxin
How to manage dosing in CKD heart failure patients
Lower doses and slower titration of ACE-I, ARB, MRA and digoxin
Which beta blockers are licensed for heart failure?
Bisoprolol
Carvedilol
Nebivolol
Which ARBs are licensed for heart failure?
Candesartan
Losartan
Valsartan
