A 66-year-old man with ischemic cardiomyopathy has dyspnea after walking two blocks. Ejection fraction is 32%. He takes carvedilol and furosemide.

Question

A 66-year-old man with ischemic cardiomyopathy has dyspnea after walking two blocks. Ejection fraction is 32%. He takes carvedilol and furosemide. Blood pressure, potassium, and eGFR are acceptable. Which of the following is the most appropriate next step in management?

Accepted Answer

Start sacubitril-valsartan after appropriate ACE inhibitor washout if needed

Answer

Use chronic oxygen therapy without hypoxemia

Answer

Add flecainide to improve ejection fraction

Answer

Start diltiazem for mortality reduction

Answer

Stop beta-blocker therapy because of dyspnea

Heart failure with reduced ejection fraction — USMLE Step 3 MCQ

A 66-year-old man with ischemic cardiomyopathy has dyspnea after walking two blocks. Ejection fraction is 32%. He takes carvedilol and furosemide. Blood pressure, potassium, and eGFR are acceptable. Which of the following is the most appropriate next step in management?