Heart failure

Question 1

HF Symptoms

Answer 1

Dyspnoea during activity or rest, exercise intolerance/fatigue. Odema (pulmonary - SOB, or peripheral)

Question 2

ARBs licensed in HF

Answer 2

Candesartan, losartan and valsartan

Question 3

Chronic HF Treatment Step 1

Answer 3

ACE/ARB + B blocker (Mild/mod stable HF &70+ : nebivolol, all grades of LVSD : bisop, carvedilol)

Question 4

Chronic HF Treatment Step 2

Answer 4

Add Spiro (or epleronone if after acute MI with LVSD or mild HF)
Alternatives: hydralazine + ISDN (esp if African/Caribbean). ARB (only w/ ACE if no alternative). Entresto (if LVEF <35% & stable dose of ACE/ARB)

Question 5

Chronic HF Treatment Step 3

Answer 5

Add Ivabradine (to standard therapy if in sinus & HR>75) OR digoxin (worsening/severe HF- doesn’t improve mortality)

Question 6

Fluid overload

Answer 6

Add diuretics (loop or TLD if mild HF - ineffective if eGFR <30)