HF

Question 1

HF symptoms

Answer 1

SOB
Ankle Swelling
Fatigue
Wheezing
Reduced exercise tolerance

Question 2

Diuretics in HF

Answer 2

Loop diuretics (furosemide, bumentaide) to help with SOB and oedema. Thiazide are only useful for mild retention

Question 3

First line therapy for HF

Answer 3

ACE (ARB if not tolerated) and BB (if already on switch to a HF BB)

EFFECT: Reduced BP, decreased workload and slower HR

Question 4

Second line therapy for HF (IF symptoms persist)

Answer 4

Add a Mineralcorticoid receptor antagonist (Spiro or Eplerenone)

Block aldosterone and prevent fluid break up

Question 5

Further treatment for HF (Persistent symptoms despite optimised standard of care)

Answer 5

• Replace ACE with Entretro (if ejection fraction <35%)
• Add a SGLT2 inhibitor (dapa,empa)
• Ivabradine (if sinus rhythm, HR>75BPM and injection fraction <35%) - inhabits the funny current
  -Hydralazine + nitrate- dilate veins and vessels. use if not tolerating ACE/ARB
• Digoxin (for sinus rhythm to improve symptoms)

Question 6

Monitoring of HF drugs

Answer 6

ACE/ARB/ALDOSTERONE ANTAGONSITS:
- Potassium, sodium and renal function should be measured at the start, 1-2 weeks into treatment, then 6 monthly)

BB:
- HR, blood pressure and symptom control at the start and after each dose change

Question 7

Non drug treatment of HF

Answer 7

smoking cessation
Reducing alcohol
Exercise
Diet