A 60-year-old man has dyspnea with mild activity that has been stable for the past year. He has a history of non- ischemic cardiomyopathy (LVEF=20). His current medications are lisinopril, carvedilol, digoxin and furosemide. He has had an implantable CVD 1 year ago. On exam BP 115/75, HR 70. Normal JVP. Clear lung. Normal CV exam, no lower limb edema. Best additional treatment?
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الإجابة: D. Spironolactone
Severe HFrEF (EF 20%) with dyspnoea on mild activity (NYHA III) despite an ACE inhibitor + beta blocker (plus digoxin, diuretic, ICD). The next mortality-reducing step is an aldosterone antagonist (spironolactone/eplerenone). Losartan should not be added to an ACE inhibitor, metolazone is only for refractory oedema (he is euvolaemic), and nifedipine is not beneficial in HFrEF.
ليش كل خيار صح أو غلط
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A
ليش غلط
An ARB is an alternative when ACEi is not tolerated; he is already on lisinopril, so it is not an add-on.
✓ (Y4)-(M B) HF.pdf · p. 5 -
B
ليش غلط
Metolazone is used to augment diuresis with loop diuretics; he is euvolaemic (normal JVP, clear lungs, no oedema).
✓ (Y4)-(M B) HF.pdf · p. 5 -
C
ليش غلط
Calcium channel blockers (except amlodipine) are on the list of medications to avoid in heart failure.
✓ (Y4)-(M B) HF.pdf · p. 6 -
D
ليش صح
Spironolactone is the third step, added to ACEi and beta-blocker for symptoms on minimal activity (NYHA 3), and it improves mortality.
✓ (Y4)-(M B) HF.pdf · p. 5
- المصدر
- (Y4)-(M B) HF.pdf · p. 5
- المحاضرة
- Heart Failure · Cardiology · Module B
- ظهر في
- Cardio bank