A 27-year-old primigravida at 34 weeks of gestation presents with orthopnea and peripheral edema. Echo shows a dilated left ventricle with an EF of 32%, and there is no prior history of cardiac disease. Which class of drugs that would normally be first line in this condition is absolutely contraindicated at this stage of pregnancy?

• A Beta blockers such as metoprolol
• B Loop diuretics such as furosemide
• C Mineralocorticoid receptor antagonists such as spironolactone
• D ACE inhibitors such as enalapril ✓

Explanation

This is peripartum cardiomyopathy, defined as new heart failure between the late third trimester and five months postpartum with LVEF below 45% and no identifiable cause. ACE inhibitors and ARBs are teratogenic, causing fetal renal failure, oligohydramnios, and skull hypoplasia, so they must be withheld until after delivery. Beta blockers, furosemide, and hydralazine-nitrate combinations can be used cautiously in pregnancy, and bromocriptine has been studied as prolactin-blocking therapy postpartum.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.