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Cardiology MCQ

 Question:

A 65-year-old man with chronic systolic heart failure (HFrEF) is started on medical therapy. Which of the following drugs has been shown to reduce mortality in HFrEF?

Options:

A. Furosemide

B. Digoxin

C. ACE inhibitors (e.g., Enalapril)

D. Nitrates alone

✅ Answer: C. ACE inhibitors (e.g., Enalapril)


Explanation:

HFrEF (EF <40%) management includes drugs that improve survival, reduce hospitalization, and relieve symptoms.

ACE inhibitors / ARBs:

Reduce mortality and morbidity.

Decrease afterload, inhibit maladaptive RAAS activation, reduce LV remodeling.

Beta-blockers (e.g., Carvedilol, Metoprolol succinate):

Also improve survival in chronic HFrEF.

Reduce sympathetic overdrive, prevent arrhythmias, improve EF over time.

Mineralocorticoid receptor antagonists (e.g., Spironolactone):

Reduce mortality in selected patients with HFrEF (EF ≤35%).

Furosemide (loop diuretic):

Symptomatic relief (reduces congestion) but does not improve survival.

Digoxin:

Improves symptoms and reduces hospitalization, no proven mortality benefit.

Nitrates alone:

May reduce preload but do not reduce mortality unless combined with hydralazine (especially in African-American patients).



References: 

Harrison’s Principles of Internal Medicine, 21st Edition, Ch. 220;

 Braunwald’s Heart Disease, 12th Edition, Ch. 43;

 UpToDate: Chronic HFrEF management.

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