Examen Único De Residencias Córdoba (Medicina) Practice Questions - Córdoba Health Residencies Single Examination (Examen Único De Residencias En Salud - Córdoba Medicina) Exam

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A 64-year-old woman with ischemic cardiomyopathy and a left ventricular ejection fraction of 28% (NYHA Class II) is evaluated in the outpatient clinic. Her blood pressure is 125/78 mmHg, heart rate is 68 bpm, and serum creatinine is 1.0 mg/dL with potassium 4.2 mEq/L. She is currently taking enalapril 10 mg twice daily and carvedilol 25 mg twice daily. According to guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), which medication modification is most appropriate to reduce mortality?

Discontinue carvedilol and initiate verapamil for better rate and blood pressure control Switch enalapril to sacubitril/valsartan (ARNI) after a 36-hour washout period, and add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin) Add digoxin and furosemide while keeping her current enalapril and carvedilol doses unchanged Discontinue enalapril and replace it with amlodipine to optimize afterload reduction

Correct Answer:

Switch enalapril to sacubitril/valsartan (ARNI) after a 36-hour washout period, and add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin)

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