Current diagnosis and management of heart failure (HF) with reduced ejection fraction (HFrEF)

1. What is the most likely cause of Mrs CT’s clinical symptoms?

2. Which of the following is NOT a common risk factor for the development of PPCM?

3. Which of the following clinical and/or biochemical tests are NOT necessary to make a diagnosis of HFrEF?

4. What is the most likely explanation for the sinus tachycardia in this patient?

5. What is the New York Heart Association (NYHA) classification of Mrs CT on this presentation?

6. Which of the HF therapies that Mr AB is taking will improve his acute symptoms, but will NOT improve his chronic HF morbidity and mortality?

7. What would you do first to optimise Mr AB’s angina symptoms and his HF prognosis?

8. Given that Mr AB deteriorated acutely while on a beta-blocker, RAAS blocker and aldactone, what changes to his therapy would you consider at this stage?

9. What is the target dose for enalapril in a patient with HFrEF?

10. What is the target dose for bisoprolol in a patient with HFrEF?

11. Which other comorbidities are not optimally controlled in this patient?

12. Mr AB’s cardiac troponins were reported as positive. Does this indicate an acute coronary syndrome?

13. During this visit you consider adding ivabradine to help optimise the autonomic dysfunction. Which of the following is not an indication for use of ivabradine?

14. Further, Mr AB reports that he is experiencing breast tissue tenderness and that his breast tissue is enlarging. Which of the following medications is the most likely culprit?

15. To better optimise Mr AB’s medication, you would like to exchange enalapril for an ARNI. What is the absolute minimum duration for the suspension of enalapril treatment before introducing the ARNI (sacubitril-valsartan)?