Heart failure

Question 1

What are symptoms of heart failure?

Answer 1

• dyspnoea* during an activity or at rest
• exercise intolerance**/ fatigue
• oedema
  (pulmonary oedema= breathlessness
  peripheral oedema***= swollen ankles, legs)

difficulty or discomfort in breathing.
** describe a person’s reduced ability or capacity to engage in physical activity or exercise compared to what is expected based on their age, fitness level, and overall health
**swelling caused by the retention of fluid in legs, ankles, feet and even sometimes in the arms and hands

Question 2

What are the NICE GUIDANCE steps for treating chronic heart failure in adults

Answer 2

1. ACEi/ ARB+ B- Blocker
2. Add spironolactone (or eplerenone after acute MI with LVSD or mild heart failure)
3. add ivrabadine or add digoxin

Question 3

Which ARBs are licensed in heart failure?

Answer 3

candersartan and valsartan

Question 4

what is the first line beta- blocker treatment for mild- mod stable heart failure and 70+?

Answer 4

nebivolol

Question 5

what is the first line treatment for ALL GRADES of patients with heart failure with LVSD (Left ventricular systolic dysfunction)

Answer 5

bisoprolol, cardevilol

Question 6

if ACEi/ ARB + B- blocker are not suitable for 1st line, what other first line treatment is available for heart failure?

Answer 6

hydralazine + isosorbide dinitrate (specialist use)

Question 7

what is the step 2 treatment for heart failure?

Answer 7

add spironolactone or EPLERENONE after acute MI with LVSD or mild heart failure

Alternatives:
- hydralazine + isosorbide dinitrate (esp in African/ Carribean)
- ARB (only give with ACEi if no other option)
- Sacubutril valsartan ( LVEF <30% and taking stable dose of ACEi/ ARB)

Question 8

what is the step 3 treatment for heart failure?

Answer 8

ADD IVARABADINE
(add to standard therapy if patient in sinus rhythm and heart rate > 75bpm)

OR

ADD DIGOXIN
(worsening or severe heart failure- does not reduce mortality)

Question 9

what is the step 1 treatment for heart failure?

Answer 9

ACEi/ ARB + B blocker

alternatives:
hydralazine + isosorbide dinitrate = specialist use

Question 10

how would you treat patients with fluid overload?

Answer 10

add on loop diuretic

add on thiazide diuretics in mild heart failure

(thiazides are ineffective in RENAL failure eGFR <30mL/min/1.73m2