A 75 year old lady has systolic heart failure and is being treated with frusemide 40 mg daily and lisinopril 20 mg daily but she remains symptomatic with very poor exercise tolerance control.

A) Her doctor decides to start treatment with a beta blocker. Which beta blockers are approved for the treatment of heart failure and what are the appropriate starting doses. (8 marks)

B) Which additional diuretic may be the most useful for this patient and what are the most important things to monitor if it is used. (4 marks)

C) What additional drug can be used to control the heart rate and when would it be appropriate to add that drug. (4 marks)

D) The patient was advised by a friend to try Entresto®. What is this drug? What is the mechanism of action and how should it be used if available? (4 marks)