A 62-year-old woman with ischemic cardiomyopathy has dyspnea despite carvedilol and lisinopril. Echocardiography shows LVEF 28 percent. eGFR is 46

Question

A 62-year-old woman with ischemic cardiomyopathy has dyspnea despite carvedilol and lisinopril. Echocardiography shows LVEF 28 percent. eGFR is 46 mL/min/1.73 m2, potassium is 4.7 mEq/L, blood pressure is 118/68 mm Hg, and she has no edema. Which of the following would you recommend?

Accepted Answer

Add an SGLT2 inhibitor and optimize guideline-directed medical therapy

Answer

Start chronic oral inotrope therapy as outpatient bridge therapy

Answer

Use furosemide as the principal mortality-reducing drug

Answer

Stop beta-blocker therapy because ejection fraction is below 30 percent

Answer

Avoid mineralocorticoid receptor antagonists because eGFR is above 30

Heart failure with reduced ejection fraction — ABIM Board MCQ

A 62-year-old woman with ischemic cardiomyopathy has dyspnea despite carvedilol and lisinopril. Echocardiography shows LVEF 28 percent. eGFR is 46 mL/min/1.73 m2, potassium is 4.7 mEq/L, blood pressure is 118/68 mm Hg, and she has no edema. Which of the following would you recommend?