Cardiac failure medicines

Many cardiac medications will remain important in managing the patient’s symptoms even in the advanced stages of cardiac failure, e.g. furosemide for breathlessness secondary to fluid overload and their management is often done in discussion with the Cardiac Failure Team.

  • Loop diuretic if fluid overload (e.g. furosemide – may be given subcutaneously via syringe driver/pump if necessary in end-stage cardiac failure)
    angiotensin-converting enzyme inhibitor (ACE inhibitor e.g. Ramipril)


  • Angiotensin-receptor blocker (ARB e.g. candesartan) if intolerant to ACEI, e.g. cough
  • Spironolactone for NYHA class III and IV (beware hyperkalaemia)
  • Beta-blocker (e.g. bisoprolol, carvedilol, nebivolol*)
  • Digoxin (for positive inotropic effects and/or rate control in atrial fibrillation)

*Best tolerated and licensed in the elderly

  • Loop diuretic if fluid overload (e.g. furosemide)
  • Rate control (to prolong LV diastole)
  • Converting to sinus rhythm if in AF (discuss with the Heart Failure Team)


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.