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Heart failure with reduced EF — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Heart failure with reduced EFUSMLE Step 3

A 61-year-old man with ischemic cardiomyopathy returns after echocardiography shows left ventricular ejection fraction 32%. He takes lisinopril and furosemide. Blood pressure is 128/76 mm Hg, potassium is 4.5 mEq/L, and eGFR is 68 mL/min/1.73 m2. He has mild exertional dyspnea but no edema. Which of the following is the most appropriate next step in management?

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Correct answer: A — Add an evidence-based beta blocker

Guideline-directed therapy for HFrEF includes ACE inhibitor/ARB/ARNI, evidence-based beta blocker, mineralocorticoid receptor antagonist when eligible, and SGLT2 inhibitor.

Reference: ACC/AHA/HFSA Heart Failure Guideline