A 71-year-old man had STEMI 3 weeks ago treated with primary PCI and stenting of the LAD. He is on aspirin, ticagrelor, atorvastatin, metoprolol, and ACE inhibitor. Echocardiography shows LVEF 32%. According to current heart failure guidelines, the next medication to add is:
- A Digoxin
- B Eplerenone ✓
- C Isosorbide mononitrate
- D Hydralazine
Explanation
The EPHESUS trial demonstrated that eplerenone (selective mineralocorticoid receptor antagonist) added to standard therapy in patients with acute MI complicated by LV dysfunction (EF ≤40%) and either heart failure or diabetes significantly reduced all-cause mortality and sudden cardiac death. Current guidelines recommend adding an MRA (eplerenone or spironolactone) to ACEI + beta-blocker in post-MI HFrEF. Digoxin has no mortality benefit. Hydralazine/nitrate is used when ACEi/ARB is not tolerated. Eplerenone is preferred over spironolactone post-MI due to less anti-androgenic side effects.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.