Internal Medicine Board Practice Questions - Saudi Board Internal Medicine Final Written Exam

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A 64-year-old woman with a history of chronic heart failure with reduced ejection fraction (HFrEF, EF 32%) presents for a routine follow-up. She is currently asymptomatic on bisoprolol 5 mg daily and lisinopril 10 mg daily. Her blood pressure is 118/76 mmHg and heart rate is 64 bpm. Which of the following is the most appropriate next step in optimizing her medical therapy?

Switch lisinopril to sacubitril-valsartan, and add spironolactone and an SGLT2 inhibitor (dapagliflozin/empagliflozin) Increase lisinopril to 20 mg daily and follow up in 3 months Add digoxin to improve left ventricular contractility Add amlodipine for additional blood pressure and heart rate control

Correct Answer:

Switch lisinopril to sacubitril-valsartan, and add spironolactone and an SGLT2 inhibitor (dapagliflozin/empagliflozin)

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