heart failure

Question 1

HF symptoms

Answer 1

SOB, persistent cough/wheeze, fatigue, reduced exercise tolerance, ankle swelling

Question 2

management of chronic HF

Answer 2

ACEi and BB - 1st line
- start at low dose and titrate up to max tolerated dose
- ARB if ACEi not tolerated
- hydralazine + nitrate if ARB + ACEi not tolerated

add aldosterone antagonist - if symptoms persist - spironolactone or eplerenone

symptoms persist: add amiodarone, digoxin, sac + val, ivabradine, dapa/empagliflozin
- digoxin in sinus rhythm in worsening HF (62.5-125mcg OD)

loop diuretics - to relieve breathlessness and oedema in fluid retention