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Heart failure fluid overload — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsHeart failure fluid overloadGPhC CRA

A GP asks for advice about a 68-year-old man with heart failure with reduced ejection fraction. He takes bisoprolol 5mg daily and ramipril 10mg daily. He now has ankle swelling, weight gain and bibasal crackles. What is the most appropriate alternative?

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

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Correct answer: A — Add a loop diuretic such as furosemide

Symptoms and signs suggest fluid overload in heart failure. A loop diuretic such as furosemide is used for symptomatic relief of congestion. Verapamil is generally avoided in heart failure with reduced ejection fraction because it can worsen cardiac function. Stopping evidence-based heart failure medicines without a clear reason would be inappropriate.

Reference: BNF; NICE CKS