GEM - heart failure including summary of NICE guidance

Heart failure can be classified in terms of:

• the ventricle affected
  • right ventricular failure
  • left ventricular failure
    • GPN reference
• diastolic versus systolic heart failure
  • GPN reference

Clinical Features of heart failure:

• with respect to the different classifications of heart failure
  • what are features of right ventricular failure
    • GPN reference
  • what are features of left ventricular failure
    • GPN reference
  • are third and fourth heart sound sensitive markers for left ventricular dysfunction?
    • with respect to the third heart sound
      • GPN reference
    • with respect to the fourth heart sound
      • GPN reference
  • be aware of the NYHA classification of heart failure
    • GPN reference

Epidemiology of heart failure:

• is heart failure common?
  • GPN reference

Assessment of possible heart failure in primary care:

• what investigations are useful in the assessment of heart failure in primary care
  • GPN reference
• what is the role of brain natriuretic peptide (BNP) in the diagnosis of chronic heart failure
  • what about patients with AF?
  • what if a patient has a normal ECG and normal BNP levels?
  • GPN reference
• ECG changes that may be seen include:
  • left ventricular hypertrophy which may be caused by chronic hypertension or aortic stenosis
  • evidence of ischaemic heart disease
  • p-mitrale of mitral stenosis
  • what is the ECG definition of LVH
    • GPN reference

Management of heart failure:

• with reference to the management of chronic heart failure
  • what medical therapies are effective in terms of reducing morbidity and mortality in chronic heart failure?
  • what medical therapies are effective in terms of symptomatic control?
  • GPN reference
• with respect to medical treatment for chronic heart failure with left ventricular dysfunction
  • ACE inhibitors in heart failure
    • which is started first, an ACE inhibitor or a beta blocker ?
      • GPN reference
      • is there evidence for the use of higher, rather than lower, doses of ACE inhibitors in chronic heart failure?
        • GPN reference
      • what about the use of ACE inhibitors in renal impairment?
        • GPN reference
  • beta blockers in heart failure
    • with respect to beta blockers in left ventricular dysfunction
      • GPN reference
      • which beta blocker, carvedilol or metoprolol?
        • GPN reference
      • which patients with heart failure should not be prescribed beta blockers?
        • GPN reference
  • aldosterone in heart failure
    • with respect to aldosterone antagonists
      • what is the concern with using this medication in combination with ACE inhibitors?
      • what is a suggested maximum dose of spironolactone in this treatment group?
        • GPN reference
      • what is eplerenone and what is the signficance of the EPHESUS
        • GPN reference
  • digoxin in heart failure
    • with respect to digoxin in heart failure
      • when should this be used?
      • GPN reference

Additional reading:

Summary of NICE heart failure guidance

• GPN reference