Heart Failure

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The clinical case of Ms. Helen Fisher

A 77-year-old female patient with diagnosed heart failure is coming to her general practitioner. She remains symptomatic and the most recent echocardiogram shows a left ejection fraction just under 35%.
Previous medical history: 4 months earlier she attended her general practitioner because of fatigue, shortness of breath, orthopnoea, and lower limbs oedema, having been diagnosed of heart failure. She also has type 2 diabetes mellitus and hypertension.

Learning goals

  • Heart Failure diagnosis and classification
  • Heart Failure according to the latest ESC guidelines


  1. Treatment optimization
  2. Follow-up

Key medication

  • Diuretics
  • Angiotensin receptor neprilysin inhibitors (ARNIs)
  • Angiotensin receptor blockers (ARBs)
  • Angiotensin-converting enzyme inhibitors (ACEIs)
  • Beta blockers
  • If Channel Blocker
  • Aldosterone Antagonists
  • Hydralazine and isosorbide dinitrate
  • Statins
  • Anticoagulants
  • Antiplatelet therapy
  • Sodium-glucose cotransporter-2 (SGLT2)


  • McDonagh, Theresa A. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal, 1-128.

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