A 54-year-old female with reduced ejection fraction heart failure remains symptomatic despite optimal doses of enalapril and metoprolol succinate. Which drug class improves survival when added next?
Answer and explanation
Correct answer: C. Mineralocorticoid receptor antagonist
- Step 1: Guidelines for heart failure with reduced ejection fraction recommend guideline-directed medical therapy.
- Step 2: Adding a mineralocorticoid receptor antagonist such as spironolactone or eplerenone significantly reduces all-cause mortality and heart failure hospitalizations.
Answer
Mineralocorticoid receptor antagonist.
Why not the others: Calcium channel blockers do not reduce mortality in heart failure with reduced ejection fraction. Loop diuretics alleviate congestive symptoms but do not demonstrate a proven mortality benefit. Direct renin inhibitors do not confer mortality reduction and increase adverse events when combined with ACE inhibitors.
Practise more Cardiovascular and Respiratory Medicine.
Free questions with an explanation for every one, and full timed DHA Dubai mock tests.
More Cardiovascular and Respiratory Medicine questions
- A 64-year-old female presents with orthopnea, paroxysmal nocturnal dyspnea, and bilateral lower extremity pitting edema. Echocardiography re…
- A 42-year-old male with a history of deep vein thrombosis presents with sudden-onset pleuritic chest pain and dyspnea. Vital signs show HR 1…
- A 70-year-old male presents with exertional syncope, angina, and dyspnea. Physical examination reveals a late-peaking harsh crescendo-decres…
- A 60-year-old female with long-standing poorly controlled hypertension presents for routine review. Her ECG reveals regular narrow-complex t…
- A 55-year-old male with a 30 pack-year smoking history presents with chronic productive cough and progressive exertional breathlessness. Pos…
- A 28-year-old male is brought to the emergency department following an acute severe asthma attack. Arterial blood gas (ABG) analysis on room…