Heart failure

Question 1

List the two types of HF

Answer 1

Acute and chronic heart failure

Question 2

Symptoms of HF

Answer 2

SoB
Pulmonary Oedema
Persistent coughing or wheezing
Ankle swelling
Reduced exercise tolerance
Fatigue

Question 3

Other symptoms of heart failure

Answer 3

Chest pains
Palpitation(if Angina present)if Angina present)
Greater risk in men, smokers, diabetic patients and increase in age

Question 4

Cause of HF

Answer 4

HTN
AF
Drugs
CHD
Cardiomyopathy
Hypothyroidism

Question 5

Diagnosis of HF

Answer 5

Physical examination
Such as faster than normal pulse, enlarged heart, signs if fluid retention eg swollen ankle, enlarged liver, crackles in the lungs
Blood test: measure BNP( B- type Natriuretic peptide or N- terminal Pro- Btype (NT-proBNP) they increase in HF
ECG, chest x Ray blood and urine

Question 6

Non drug tx of HF

Answer 6

Life style changes eg smoking cessation, exercise, reduce alcohol consumption
<6g of salt recommended daily
Daily weight check, weight gain of 1.5-2.0kg in 2days should be reported to GP

Question 7

Drugs used to tx HF with reduced Ejection fraction

Answer 7

Ace inhibitors/ARB( diabetic or fluid overload
+BB( Angina)
Then
MRA eg eplerenone/ Spironolactone
Then
Hydralazine %Nitrate ( to African and carribean
Then
Specialist
Such as sacubitril, Ivabradine, Hydralazine and Digoxin ( HF + Arrhythmia)
Loop diuretics ( Oedema and breathlessness)
Dapagliflozin

Question 8

Drugs used on HF

Answer 8

ABCD
Ace inhibitors
ARB
BB
Loop diuretics
Then specialist area

Question 9

Memory trick for HF drugs

Answer 9

BANDAIDS
Beta blockers
Ace inhibitors/ARBs
Nitrate/Hydralazine
Diuretics
Amiodarone
Ivabradine
Digoxin
Sacubitril Valsartan

Question 10

Otc drug not suitable for patients with HF due to sodium retention

Answer 10

NSAIDS

Question 11

First line tx for HF in pts with Angina

Answer 11

BB

Question 12

First line tx for HF in pt with diabetes or fluid overload

Answer 12

ACE

Question 13

ARB offered to patient with HF if…

Answer 13

They can’t take ACE due to dry cough

Question 14

Examples of Ace inhibitors licensed for HF

Answer 14

Perindopril, ramipril, captopril, enalapril, lisinopril, quinalapril and fosinopril

Question 15

Examples of BB licensed for HF

Answer 15

Bisoprolol, carvedilol, nebivolol
Do not withhold BB for age, pt with diabetes, COPd, PVD or erectile dysfunction

Question 16

ARB licensed for HF

Answer 16

Candersatan, lorsartan, Valsartan
Consider if ACE not tolerated

Question 17

State when digoxin is given in HF

Answer 17

Patient with HF and sinus rhythm as add on therapy