Chronic Heart Failure Management — UKMLA MCQ

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HardCardiologyChronic Heart Failure ManagementUKMLA MRCP Part 1 PARA PSA

A patient with stable HFrEF, LVEF 32%, takes ramipril, bisoprolol and dapagliflozin. He remains symptomatic. Potassium is 4.3 mmol/L and eGFR 56 mL/min/1.73 m². Which addition completes the core NICE disease-modifying combination?

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Correct answer: B — Eplerenone

B is correct. The 2025 NICE HFrEF combination comprises an ACE inhibitor, evidence-based beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor. Eplerenone supplies the missing MRA, with potassium and renal monitoring. A and D can have selected additional roles but do not replace a missing core class. C has no equivalent prognostic role. E can worsen HFrEF. Medicines should be introduced individually at low dose with clinical and biochemical review.

Reference: NICE NG106: chronic heart failure in adults: https://www.nice.org.uk/guidance/ng106/chapter/Recommendations GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map