Many cardiac medications will remain important in managing the patient’s symptoms even in the advanced stages of cardiac failure, e.g. furosemide for breathlessness secondary to fluid overload and their management is often done in discussion with the Cardiac Failure Team.
Cardiac failure medicines
Cardiac failure with LVSD
- Loop diuretic if fluid overload (e.g. furosemide – may be given subcutaneously via syringe driver/pump if necessary in end-stage cardiac failure)
angiotensin-converting enzyme inhibitor (ACE inhibitor e.g. Ramipril)
Or
- Angiotensin-receptor blocker (ARB e.g. candesartan) if intolerant to ACEI, e.g. cough
- Spironolactone for NYHA class III and IV (beware hyperkalaemia)
- Beta-blocker (e.g. bisoprolol, carvedilol, nebivolol*)
- Digoxin (for positive inotropic effects and/or rate control in atrial fibrillation)
*Best tolerated and licensed in the elderly
Diastolic heart failure
- Loop diuretic if fluid overload (e.g. furosemide)
- Rate control (to prolong LV diastole)
- Converting to sinus rhythm if in AF (discuss with the Heart Failure Team)