A 55-year-old woman with a 3-year history of systolic heart failure (ejection fraction 28%) presents to clinic for medication optimization. She reports persistent dyspnea on exertion despite currently taking lisinopril 10 mg daily and metoprolol succinate 95 mg daily. Vital signs: BP 112/70 mmHg, HR 68 bpm, RR 16. Laboratory values: serum potassium 5.9 mEq/L, creatinine 1.7 mg/dL, BUN 28 mg/dL, sodium 137 mEq/L. Recent echocardiography confirms ejection fraction of 28% with dilated left ventricle. The patient denies chest pain, palpitations, or syncope. You plan to add an additional agent with mortality benefit in systolic heart failure. Which of the following medications is contraindicated in this patient at this time?
- A)Sacubitril/valsartan
- B)Ivabradine
- C)SpironolactoneGABARITO
- D)Digoxin
- E)Hydralazine-isosorbide dinitrate
Explicação
Spironolactone is contraindicated in this patient due to hyperkalemia (K+ 5.9 mEq/L, normal <5.0) and renal dysfunction (Cr 1.7 mg/dL). Spironolactone is a potassium-sparing aldosterone antagonist that increases serum potassium levels, particularly in patients... Ver explicação completa e trilha adaptativa →