Examen Integrado - Medicina Practice Questions - Argentina Medical Residencies Integrated Examination (Examen Integrado De Residencias De La Salud - Medicina) Exam

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A 64-year-old male with ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 30%, NYHA Functional Class II) presents for follow-up. He is currently asymptomatic on enalapril 10 mg twice daily and bisoprolol 10 mg daily. His blood pressure is 118/72 mmHg, heart rate is 64 bpm, serum potassium is 4.3 mEq/L, and estimated GFR is 68 mL/min/1.73 m2. To reduce cardiovascular mortality and heart failure hospitalizations according to guideline-directed medical therapy (GDMT), which medication should be added next?

A mineralocorticoid receptor antagonist (e.g., Spironolactone 25 mg daily) and an SGLT2 inhibitor (e.g., Empagliflozin 10 mg daily) Digoxin 0.25 mg daily to enhance left ventricular inotropic contractility Amlodipine 10 mg daily for further afterload reduction and blood pressure control Furosemide 40 mg daily as routine disease-modifying therapy despite absence of congestion

Correct Answer:

A mineralocorticoid receptor antagonist (e.g., Spironolactone 25 mg daily) and an SGLT2 inhibitor (e.g., Empagliflozin 10 mg daily)

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