HFrEF-Diuretic Resistance — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiologyHFrEF-Diuretic ResistanceEECC

A 70-year-old with HFrEF and persistent volume overload despite high-dose loop diuretics. Which adjunct improves natriuresis acutely?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Add thiazide-like diuretic (sequential nephron blockade)

Sequential nephron blockade with a thiazide-like diuretic (e.g., metolazone) enhances diuresis when loops alone are inadequate. NSAIDs (B) worsen renal perfusion and sodium retention. CCBs (C) do not improve diuresis. Stopping loops (D) worsens congestion. ACEi (E) improves outcomes but not acute natriuresis.

Reference: AHA/ACC/HFSA Guideline (2022): Heart Failure (Secondary Source)