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Perioperative HF Medication Management — EECC MCQ

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HardGeneral CardiologyPerioperative HF Medication ManagementEECC

A patient with HFrEF and type 2 diabetes takes dapagliflozin and sacubitril/valsartan. Elective major surgery is planned. Which medication instruction most directly reduces perioperative euglycaemic ketoacidosis risk?

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

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Correct answer: A — Withhold dapagliflozin in advance of major surgery

SGLT2 inhibitors can precipitate perioperative euglycaemic ketoacidosis, so they should be withheld before major surgery according to the local protocol rather than merely omitted on the morning. Restart requires clinical stability, adequate oral intake and absence of ketosis. Normal glucose does not exclude the complication. Other heart-failure medicines need their own haemodynamic assessment, but the question specifically targets the distinctive SGLT2 risk. Permanent withdrawal sacrifices prognostic benefit unless a continuing contraindication develops.

Reference: 2022 ESC Guidelines on cardiovascular assessment and management for non-cardiac surgery. https://www.escardio.org/guidelines/clinical-practice-guidelines/cardiovascular-assessment-and-management-of-patients-undergoing-non-cardiac-surgery/