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Heart failure with reduced ejection fraction — ABFM Board MCQ

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HardCardiovascularHeart failure with reduced ejection fractionABFM Board

A 69-year-old woman has progressive exertional dyspnea and ankle swelling. BNP is elevated, chest radiograph shows pulmonary vascular congestion, and echocardiogram shows left ventricular ejection fraction of 32%. Blood pressure is 146/84 mm Hg and creatinine is 1.0 mg/dL. Which of the following is the most appropriate initial treatment?

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Correct answer: B — Guideline-directed heart failure therapy including ARNI/ACE inhibitor, beta blocker, MRA, and SGLT2 inhibitor as tolerated

Heart failure with reduced ejection fraction is treated with foundational guideline-directed therapy: ARNI or ACE inhibitor/ARB, evidence-based beta blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor as tolerated. Congestion also requires diuretic treatment.

Reference: ACC/AHA/HFSA Heart Failure Guideline