Eidgenössisches Examen Humanmedizin Practice Questions - Eidgenössische Prüfung In Humanmedizin Examen Fédéral En Médecine Humaine Exam

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A 64-year-old female with ischemic cardiomyopathy presents for outpatient follow-up. Transthoracic echocardiography reveals a left ventricular ejection fraction (LVEF) of 28% with global hypokinesia. She reports dyspnea when walking up one flight of stairs (NYHA Class II). Her current medications are bisoprolol 5 mg daily and ramipril 5 mg daily. Blood pressure is 122/74 mmHg, heart rate is 68 bpm, eGFR is 62 mL/min/1.73m², and serum potassium is 4.3 mmol/L. According to ESC Heart Failure guidelines, which medical regimen constitutes optimal quadruple guideline-directed medical therapy (GDMT)?

Continue bisoprolol and ramipril, and add digoxin and ivabradine Switch ramipril to an ARNI (sacubitril/valsartan), maintain bisoprolol, add a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and add an SGLT2 inhibitor (dapagliflozin or empagliflozin) Discontinue bisoprolol, increase ramipril to maximum tolerated dose, and initiate hydralazine plus isosorbide dinitrate monotherapy Add amiodarone and furosemide while maintaining current doses of bisoprolol and ramipril without further neurohormonal blockade

Correct Answer:

Switch ramipril to an ARNI (sacubitril/valsartan), maintain bisoprolol, add a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and add an SGLT2 inhibitor (dapagliflozin or empagliflozin)

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