General Medicine
Heart Failure: Management
Heart failure management for MBBS: the four foundational drug classes, device therapy, valvular disease, rheumatic fever prophylaxis and rehabilitation, mapped to NMC codes IM1.18 to IM1.30.
MedNext Academy | 3 min read
Heart Failure: Management
Heart failure management for MBBS: the four foundational drug classes, device therapy, valvular disease, rheumatic fever prophylaxis and rehabilitation, mapped to NMC codes IM1.18 to IM1.30.
This chapter turns the pathophysiology of heart failure into a treatment plan, covering the four foundational drug classes, device therapy and the management of valvular disease. It also addresses rheumatic fever prophylaxis, self-care counselling, cardiac rehabilitation and palliative care in advanced disease.
High-yield: Heart Failure: Management
- The four foundational drug classes for reduced ejection fraction failure are ACE inhibitors or ARNI, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.
- Angiotensin receptor-neprilysin inhibitor is superior to an ACE inhibitor for reducing mortality in suitable reduced ejection fraction patients.
- Beta-blockers must be started at a low dose in a stable, euvolaemic patient and never during acute decompensation.
- Diuretics relieve congestion and symptoms but have not been shown to reduce mortality on their own.
- Mineralocorticoid receptor antagonists reduce mortality but need monitoring of potassium and renal function.
- SGLT2 inhibitors reduce hospitalisation and death across both reduced and preserved ejection fraction failure.
- An implantable cardioverter defibrillator is considered when the ejection fraction stays at or below 35% despite optimal therapy.
- Cardiac resynchronisation therapy helps selected patients with a wide QRS and left bundle branch block morphology.
- Secondary prophylaxis with long-acting penicillin prevents recurrence of rheumatic fever and progression of rheumatic heart disease.
- Percutaneous transvenous mitral commissurotomy is the procedure of choice for suitable pliable rheumatic mitral stenosis.
- Salt restriction and daily weight monitoring are core self-care measures to detect early fluid retention.
- Ivabradine can be added when the heart rate stays high despite a maximally tolerated beta-blocker in sinus rhythm.
- Endocarditis prophylaxis is now limited to the highest-risk cardiac lesions undergoing specific dental or invasive procedures.
- Cardiac rehabilitation improves functional capacity and quality of life in stable chronic heart failure.
- Palliative care planning is appropriate in end-stage failure refractory to optimal medical and device therapy.
Foundational therapy in reduced ejection fraction failure
- **Renin-angiotensin blockade:** ACE inhibitor, ARB or the superior ARNI to reduce mortality and remodelling.
- **Beta-blocker:** Started low in a stable, euvolaemic patient; never during acute decompensation.
- **MRA and SGLT2 inhibitor:** Both reduce death and hospitalisation; monitor potassium and renal function with the MRA.
- **Devices:** Defibrillator if ejection fraction stays 35% or below; resynchronisation for wide QRS with left bundle branch block.
NMC competencies in this chapter
- **IM1.18:** Pharmacology of drugs used in heart failure
- **IM1.19:** Defibrillator and cardiac resynchronisation therapy
- **IM1.20:** Medical and surgical management of valvular heart disease
- **IM1.22:** Rheumatic fever prophylaxis and prevention of rheumatic heart disease
- **IM1.23:** Endocarditis prophylaxis
- **IM1.26:** Fluid and sodium management in heart failure
- **IM1.29:** Cardiac rehabilitation in chronic heart failure
- **IM1.30:** Palliative care in end-stage heart failure
Frequently Asked Questions
Which drugs improve survival in heart failure?
The four foundational classes are renin-angiotensin blockers or ARNI, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors; diuretics relieve symptoms but do not improve survival by themselves.
When is a beta-blocker safe to start?
Only in a stable, euvolaemic patient at a low dose with gradual up-titration; it should never be introduced during acute decompensation because it can worsen congestion.
Who needs an implantable defibrillator?
It is considered when the ejection fraction remains at or below 35% despite optimal medical therapy, to prevent sudden cardiac death from ventricular arrhythmia.
How does this chapter help for NEET-PG?
The mortality-reducing drug classes, device indications and rheumatic fever prophylaxis are common exam themes, so a structured management framework maps directly to typical questions.
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