Cardiology MCQ: Add on therapy in heart failure

Preferred add on therapy in heart failure, to ACE inhibitors and beta blockers: a) Angiotensin receptor blocker b) Mineralocorticoid antagonist c) Renin antagonist d) None of the above Correct answer: b) Mineralocorticoid antagonist Mineralocorticoid antagonist like spironolactone or eplerenone is the add on therapy in heart failure to angiotensin converting enzyme inhibitors (ACEI) and beta blockers in the management of heart failure. Spironolactone has been shown to reduce myocardial fibrosis and corrected QT interval (QTc) [Wong KY et al. Myocardial fibrosis and QTc are reduced following treatment with spironolactone or amiloride in stroke survivors: a randomised placebo-controlled cross-over trial. Int J Cardiol. 2013;168:5229-33]. While combining mineralocorticoid antagonists to ACE inhibitors, serum potassium levels have to be checked, especially if the renal function is borderline, as there is a chance for hyperkalemia. This is because both mineralocorticoid antagonists and ACE inhibitors have a potential for causing potassium retention, which can be more pronounced in those with borderline renal function. Beta blockers may also have some effect in elevating potassium levels as they block renin release and act proximally in the renin-angiotensin-aldosterone axis. Angiotensin receptor blockers (ARB) and renin antagonist (e.g. aliskiren) are not preferred as add on therapy to ACE inhibitors. ARBs with proven benefit in heart failure like valsartan and candesartan may be...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs