Heart failure

Question 1

what are some symptoms of heart failure?

Answer 1

-dyspnoea(sob)- during an activity or at rest
-exercise intolerance/ fatigue
-oedema either pulmonary =breathlessness or peripheral= swollen legs and ankles

Question 2

what is the first treatment for heart failure?

Answer 2

-ACEi/ARC +b-blocker
~ARB licensed in HF= candesartan, valsartan
~mild-mod stable hf and 70+ = nebivolol
~All grades of LVSD =bisoprolol, cardevilol
~alternatives: hydralazine+isos

Question 3

what is the second steps for treatment for heart failure?

Answer 3

-add spironolactone (or eplerenone after acute MI with LVSD or mild HF)
-alternatives :
~hydralazine +isosorbide denigrate (esp in Africans)
~ARB (only give with ACEi if no other option)
~sacubutril valsartan (LVEF<35% and taking stable dose of ACEi/ARB)

Question 4

What is the third step step for treatment of heart failure?

Answer 4

-add ivrabadine
(added to standard therapy if patient in sinus rhythm and heart rate >75bpm)
OR
-add digoxin=worsening or severe heart failure, doesn’t reduce mortality

Question 5

what is the treatment for fluid overload?

Answer 5

-add on loop diurectis
-add on thiazide diuretics in mild HF. Thiazides are ineffective in renal failure eGFR<30ml/min/1.73m2

Question 6

what are the 4 pillars?

Answer 6

ACE
BETA BLOCKER
SPIRONOLACTONE
Dapagliflozin