skip to main content

HFrEF follow-up after hospitalization — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardInternal Medicine (chronic management)HFrEF follow-up after hospitalizationUSMLE Step 3

A 69-year-old man with heart failure with reduced ejection fraction returns after hospitalization. Echocardiography shows LVEF 30%. He takes lisinopril and furosemide. Blood pressure is 122/72 mm Hg, pulse is 78/min, potassium is 4.4 mEq/L, and eGFR is 68 mL/min/1.73 m2. He has no volume overload. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Add evidence-based beta-blocker therapy

Stable HFrEF should be treated with guideline-directed medical therapy including an evidence-based beta-blocker, RAAS inhibition/ARNI, mineralocorticoid receptor antagonist, and SGLT2 inhibitor as tolerated. Diltiazem can worsen HFrEF.

Reference: 2022 AHA/ACC/HFSA Heart Failure Guideline