Cardiology>>>>>Heart Failure
Question 3#

You review a 60-year-old man with NHYA class II heart failure in clinic. He has LVEF 35%, BP 110/50 mmHg, and heart rate 80 bpm (sinus rhythm). Current medications are bisoprolol 1.25 mg and ramipril 7.5mg.

What medication alteration would you recommend to the GP?

A. Add ivabradine
B. Add spironolactone 25 mg od
C. Add digoxin 62.5 micrograms od
D. Titrate up bisoprolol
E. Add candesartan 4 mg

Correct Answer is D


The patient is not on optimal dosage of BB with a heart rate of 80 bpm; therefore titrate BB in the first instance before adding further agents. The target dose of bisoprolol is 10 mg or as close as tolerated. An MRA would be next line if the patient remains in NYHA class II+, followed by ivabradine if the heart rate remains >70 bpm.