Potentially reversible symptoms
Symptom/s
Reversible cause/s
Breathlessness
fluid overload – optimise diuretic therapy – consider if SC or IV more appropriate
Consider Digoxin toxicity
Reduced blood pressure, Diuresis and fluid restriction
Cough
ACE inhibitor therapy
Malaise, Lethargy
Hypokalaemia, Beta-blocker therapy
Abdominal bloating
Gut wall oedema, Constipation
Drugs to avoid
Some drugs used generally in palliative care for symptom control may worsen heart failure and these should be avoided or used with caution. The following table gives guidance with regard to drugs which may cause particular problems. Advice should be sought from the Specialist Palliative Care Team or Heart Failure Team if there are particular concerns.
Drug to avoid
Problematic Side Effects In Heart Failure
Non-steroidal anti-inflammatory drugs
Cause sodium and water retention and can worsen renal function
Cause water retention.
Risk of hyperglycaemia
Cause water retention
Anticholinergic:
Can cause cardiac arrhythmias
Hyponatraemia and postural hypotension
Should be avoided in heart disease particularly if there is a history of arrhythmias
SSRI’s and mirtazapine are safer
Anticholinergic antihistamine:
May cause arrhythmias and hypotension.
Avoid in severe heart failure
Anticholinergic: Use with caution in heart disease.
Avoid as contains high sodium load and requires increased fluid intake which may not be appropriate with heart failure
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.