CSB601 Chap.6 Heart Failure and Coronary Heart Disease
Heart Failure and Coronary Heart Disease
Heart failure foundations and anti-anginal logic
This chapter links heart failure and coronary heart disease through the same cardiovascular medicines.
It sorts heart failure by ejection fraction, maps ACE inhibitors, sartans, beta blockers, mineralocorticoid receptor antagonists, sacubitril with valsartan and SGLT2 inhibitors to the pathways they interrupt, and separates them from symptom relievers such as loop diuretics.
The angina section explains oxygen supply and demand, nitrate use and secondary prevention after acute coronary syndrome.
How cases in Weeks 4 and 5 test it
Cases ask which medicines change prognosis, why a beta blocker is added, which over-the-counter analgesics endanger the kidneys, and why a nitrate patch stops working without a daily break.
What this chapter covers
- 01
Ejection Fraction Categories
- 02
Foundation Therapy in HFrEF
- 03
Potassium and Renal Monitoring
- 04
Symptom-Relieving Diuretics
- 05
Anti-Anginal Drug Choices
- 06
Secondary Prevention After ACS
Worked example · free
High potassium and congestion before a beta blocker
- 2A potassium above 6 mmol/L means spironolactone is stopped immediately, then reintroduced cautiously at a lower dose once potassium falls below 5 mmol/L, with renal function and electrolytes rechecked.
- 2Beta blockers start only when a patient is stable and euvolaemic, because early doses can worsen heart failure and lower blood pressure, so the start waits while she is congested.
- 2Congestion is relieved with a loop diuretic and tracked with daily weights; once stable, a heart-failure beta blocker at a very low dose and an SGLT2 inhibitor complete foundation therapy.
Key terms
- Ejection Fraction
- The percentage of blood in the left ventricle that is pumped out with each contraction, used to classify heart failure.
- Mineralocorticoid Receptor Antagonist
- A drug such as spironolactone or eplerenone that blocks aldosterone, increasing sodium excretion and retaining potassium.
- Nitrate-Free Interval
- A daily period of 10 to 12 hours without long-acting nitrate exposure that prevents tolerance.
- Dual Antiplatelet Therapy
- Aspirin combined with a P2Y12 inhibitor such as clopidogrel or ticagrelor, given for at least 12 months after an acute coronary syndrome.
Heart Failure and Coronary Heart Disease FAQ
Why are beta blockers used in heart failure if they slow the heart?
Long-term sympathetic overdrive speeds the heart, raises oxygen demand and drives arrhythmias and progressive ventricular damage. Selected beta blockers counter this, improving ventricular function, admissions and survival in reduced ejection fraction. Because early doses can briefly worsen symptoms or lower blood pressure, they start only in stable, euvolaemic patients at a very low dose that rises slowly.
Does frusemide help people with heart failure live longer?
Its effect on survival has not been studied in heart failure. Frusemide relieves breathlessness and swelling and improves exercise tolerance through a strong, short diuresis in the loop of Henle. Doses are taken in the morning, with any second dose by early afternoon, and weight and electrolytes are monitored because sodium, potassium and magnesium can fall.
Can someone who uses glyceryl trinitrate also take sildenafil?
No. Teaching slides list phosphodiesterase-5 inhibitors such as sildenafil, tadalafil and vardenafil as contraindicated with nitrates, because the combination can cause profound hypotension and even myocardial infarction. A medication history for anyone with angina should ask directly about these products, including those bought without a prescription or online.
How long does aspirin continue after an acute coronary syndrome?
Aspirin is continued indefinitely after the event unless a reason for anticoagulation appears. For at least the first 12 months it is paired with clopidogrel or ticagrelor, and that pairing can extend when the risk of further ischaemia outweighs the bleeding risk. A statin, beta blocker and ACE inhibitor are usually part of the same long-term plan.
Exam move
Split revision into two halves. For heart failure, draw the angiotensin pathway and mark every drug block point, then list the classes that change survival in reduced ejection fraction beside the ones that only relieve symptoms; examiners often ask you to sort a patient's list exactly this way.
Memorise the potassium thresholds for spironolactone and the 36-hour gap before sacubitril with valsartan, since numbers are easy multiple choice targets. Write out the drugs to avoid in heart failure, because NSAIDs and verapamil appear in case stems. For angina, practise the oxygen supply and demand logic until you can place nitrates, beta blockers and both calcium channel blocker types in one sentence each.
Finish with two short answers: one about nitrate tolerance from a patch worn continuously, and one listing secondary prevention after an acute coronary syndrome, each limited to five lines.
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