PROGNOSIS, KEY INFORMATION, MEDICATION
PROGNOSIS
Complications:
– Sudden cardiac death
– Sexual dysfunction
– CKD
– Depression
– Arrhythmias
KEY INFORMATION
Referral criteria:
– Raised BNP/NT-proBNP (level of urgency depends upon the numerical value) – Valvular cause (aortic stenosis)
NYHA class 4
EF <35% – Symptoms not controlled in primary care Pregnancy planning with reduced EF Key Follow-ups: – 6-monthly once stable – ACE/ARBS: Monitor U&Es: baseline, 2 weeks, then 3-6 Monthly – Stop ACE/ARBs & seek advice if K+ is >5.5
MEDICATION
1. ARBs (Candesartan, losartan, valsartan) Contraindications:
– Angioedema
– CKD
– Pregnancy/breastfeeding
– Renal artery stenosis – ARBs contain lactose – avoiding galactose intolerance
– pre-treatment potassium of
>5
– hepatic impairment
Side-effects:
– hypotensive
– deterioration of the renal function (Cr & egfr)
– hyperkalaemia
- Beta-blockers (bisoprolol, carvedilol, nebivolol) should only be started once the patient is stable and there are no fluid overload symptoms. When starting, titre up slowly and avoid abrupt stoppage due to the risk of rebound myocardial issues (MI, arrhythmias). Contraindications:
| – Uncontrolled heart failure
– Asthma/COPD – Symptomatic bradycardia – SA/AV blocks – specific to Bisoprolol & Carvedilol (pregnancy & breastfeeding) |
– Severe hypotension
– Raynaud’s, PAD – Hepatic dysfunction – contains lactose (avoid in galactose intolerance) |
Side effects:
- Worsening heart failure symptoms
- bradycardia and hypotension
- ACEi
- Most of the profile is very similar to ARB’s
- things to note: side effects can include Angioedema and cough
- Diuretics (Usually furosemide is used, if guy oedema use budesonide) Contraindications:
- hypovolaemia
- hypokalaemia & hyponatraemia
- AKI
- CKD with creatinine and clearance of < 30
Side effects:
- increase blood sugars
- acute urinary retention
- hyponatraemia, hypokalaemia, hypomagnesemia and hypocalcaemia
- metabolic alkalosis
- hyperuricaemia
- SGLT2 inhibitors: Contraindication:
- eGFR <15 (dapagliflozin)
- eGFR <20 (empagliflozin)
- DKA risk
- Hepatic impairment
Side-effects:
- Angio-oedema
- back pain, constipation, dry mouth
- dyslipidaemia, DKA, necrotising fasciitis of the perineum – UTIs, Vulvovaginitis, Balanoposthitis.