Question

A 74-year-old man with long-standing hypertension and a prior myocardial infarction presents for follow-up. Echocardiography shows a left ventricular ejection fraction of 30% consistent with heart failure with reduced ejection fraction (HFrEF). He is euvolaemic and currently on ramipril and furosemide only. According to contemporary Canadian heart failure guidance, which change to his chronic outpatient regimen is most appropriate?

Accepted Answer

Add a guideline-directed beta-blocker, mineralocorticoid receptor antagonist, and an SGLT2 inhibitor over time as tolerated

Answer

Stop ramipril and continue furosemide alone to avoid hypotension

Answer

Switch furosemide to a thiazide diuretic and increase the dose of ramipril only

Answer

Start an intravenous inotrope as an outpatient to improve cardiac output

Answer

Stop the ACE inhibitor and use a calcium-channel blocker instead

Practice question