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GEM - heart failure including summary of NICE guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Heart failure can be classified in terms of:

  • the ventricle affected
  • diastolic versus systolic heart failure

Clinical Features of heart failure:

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

Epidemiology of heart failure:

Assessment of possible heart failure in primary care:

  • what investigations are useful in the assessment of heart failure in primary care
  • 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

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?
        • what about the use of ACE inhibitors in renal impairment?
    • beta blockers in heart failure
      • with respect to beta blockers in left ventricular dysfunction
    • 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?
        • what is eplerenone and what is the signficance of the EPHESUS
    • digoxin in heart failure
      • with respect to digoxin in heart failure

Additional reading:

Summary of NICE heart failure guidance

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