- 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)
Or
- 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