FCP(SA) Part II Practice Questions - Fellowship Of The College Of Physicians Of South Africa Part II Exam

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A 58-year-old male with long-standing ischemic heart disease and an LVEF of 28% remains symptomatic (NYHA Class III) on enalapril 10 mg twice daily and carvedilol 25 mg twice daily. Blood pressure is 124/76 mmHg, heart rate is 68 bpm, serum potassium is 4.3 mmol/L, and eGFR is 62 mL/min/1.73m². What is the most appropriate next step in optimizing guideline-directed medical therapy (GDMT)?

Add digoxin and increase carvedilol to 50 mg twice daily Discontinue carvedilol and initiate ivabradine 5 mg twice daily Switch enalapril to sacubitril/valsartan, and add spironolactone and dapagliflozin Add hydralazine and isosorbide dinitrate while maintaining current enalapril

Correct Answer:

Switch enalapril to sacubitril/valsartan, and add spironolactone and dapagliflozin

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