HFrEF-Diuretic Resistance — EECC MCQ

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ModerateCardiologyHFrEF-Diuretic ResistanceEECC

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

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

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

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)