Heart Failure

Question 1

Symptoms of HF

Answer 1

SOB, weight gain, persistent cough, loss of apetite, fatigure, pulmonary crackles

Question 2

Most common cause of HF

Answer 2

CHD

Question 3

Two types of HF

Answer 3

HF with reduced EF (<40%) and HF with preserved EF

Question 4

Biomarker of HF

Answer 4

NF proBNP (>2000ng/L)

Question 5

Non drug treatment of HF

Answer 5

smoking cessation, exercise, diet (<6g salt a day), implantable cardioverter defibrilators

Question 6

What must all patients with HF have adminsitered annually?

Answer 6

Flu vaccine

Question 7

Drug treatment for Chronic HF with REF

Answer 7

1. diuretics - loop
2. ACEi / ARB
3. Beta blocker (bisoprolol, carediolol, nebivolol)
   - -> if symptoms persist
4. aldosterone antagonist e.g. Spiro
5. Hydralazine + nitrate
   - -> if symptoms still persist
6. Amiodarone / Digoxin / Ivabradine / sacubutril + valsartan

Question 8

What are the purpose of beta blockers in HF?

Answer 8

reduce mortality

Question 9

If a patient is already on a Beta blocker but develops HF what does the BNF recommend?

Answer 9

Switch to licensed BB for HF e.g. Bisoprolol, navedilol or carvedilol

Question 10

When is Sacubitril + valsartan considered in HF treatment?

Answer 10

If EF <35%

Question 11

What drug inhibits breakdown of natriuetic peptide?

Answer 11

Sacubutril + valsartan (Entresto)

Question 12

What orgain impairment requires monitoring with Entresto?

Answer 12

Liver impairment - if hepatic enzymes exceed 2 times ULN / avoid in severe hepatic impairment / choleostasis

Question 13

If hepatic transaminase is 2 x ULN what do you do to dose of Entresto?

Answer 13

Reduce to 24/26mg BD

Question 14

If eGFR <30ml/min, what dose do you start Entresto at?

Answer 14

24/26mg BD

Question 15

What criteria (NICE TA) is required for starting entresto?

Answer 15

If REF with NYHFA II - IV and LV EF <35% and already on ACEi/ARB