Heart failure

Question 1

How would a patient with suspected HF be managed?

Answer 1

If symptoms are severe:
Furosemide 20-40mg daily
Bumetanide-0.5-1mg daily
Torasemide 5-10mg daily

Question 2

What FIVE classes of drugs would you expect to be prescribed?

Answer 2

AIIRAs
ACEi
SGLT-2 Inhibitors
Diuretics
Beta blocker

Question 3

Acute HF
How is it diagnosed?

Answer 3

ECG
Echo
Blood- serum natriuretic peptides

Question 4

ACUTE HF
What is the initial treatment?

Answer 4

Diuretics (IV BOLUS)
Ventilate (only severe symptoms)

Question 5

What is treatment after stabilisation?

Answer 5

BB
ACEi
MRA

Question 6

CHRONIC HF
How is it diagnosed?

Answer 6

ECG
Echo
Bloods NT-proBNP
Chest x ray
Urinalysis
Peak flow/spirometry

Question 7

CHRONIC HF
What is first line treatment?

Answer 7

Diuretic
ACEi
BB
Nitrate and hydrazine (if intolerant to ACEi/ARB)

Question 8

CHRONIC HF
What is lifestyle advice

Answer 8

HF can be debilitating and depression is common

Lower or stop alcohol

Excercise if stable

Annual flu and pneumococcal vaccine
Stop smoking
Report weight gain >1.5- 2kg
Air travel possible

Implantable cardioverter defibrillators and cardiac resynchronisation therapy are treatment options recommended in patients with heart failure and a reduced ejection fraction of less than 35%.

Question 9

What should be avoided in HF?

Answer 9

Rate limiting CCB
Short acting dihydropyridines
(nifedipine or nircadipine)

As it can reduce cardiac contractility

Amodipine CAN be used

Question 10

What are symptoms of heart failure?

Answer 10

persistent coughing or wheezing, ankle swelling, reduced exercise tolerance, and fatigue. These symptoms may be accompanied by signs such as elevated jugular venous pressure, pulmonary crackles, and pulmonary oedema.

Question 11

Can a patient still be given a beta blocker even with COPD, diabetes, PVD and erectile dysfunction?

Answer 11

Yes

not contraindicated in line of treatment.

Question 12

What can be given if HF symptoms persist despite optimal first line treatment?

Answer 12

MRA
as add on therapy unless contraindicated

Question 13

What are other options if first and second line do not help?

Answer 13

Amiodarone
Digoxin
Entresto
Valsartan
SGLT-2
Ivrabadine
All need specialist advice before initiation

Question 14

What are monitoring requirements for drug treatment?

Answer 14

Renal function
sodium
BP
Prior to starting and 1-2 weeks after starting.

Question 15

Who are at greater risk of HF?

Answer 15

Men
smokers
diabetics
age