Reválida Médica UBA Practice Questions - Examen General De Competencias Profesionales Para Reválida De Título Médico Extranjero (Universidad De Buenos Aires) Exam

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A 64-year-old male with a history of anterior myocardial infarction has heart failure with reduced ejection fraction (LVEF 28%). He is currently receiving enalapril 10 mg twice daily and bisoprolol 5 mg daily. He remains in NYHA functional class II with an eGFR of 52 mL/min/1.73 m² and serum potassium of 4.3 mEq/L. Which pharmacological combination represents the most guideline-directed next step to reduce mortality?

Add digoxin and increase the dose of loop diuretics Add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin) Discontinue bisoprolol and start diltiazem for rate control Add oral hydralazine and isosorbide dinitrate while discontinuing enalapril

Correct Answer:

Add a mineralocorticoid receptor antagonist (spironolactone) and an SGLT2 inhibitor (dapagliflozin or empagliflozin)

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