Cardiology: survival drugs in HFrEF: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: survival drugs in HFrEF

Sample item

Which set of drugs improves survival in heart failure with reduced ejection fraction?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. ARNI or ACE inhibitor, evidence-based beta blocker, MRA and SGLT2 inhibitor

The four pillars of HFrEF therapy are ACE inhibitor or ARNI, bisoprolol, carvedilol or metoprolol succinate, mineralocorticoid antagonist and SGLT2 inhibitor. Loop diuretics and digoxin relieve symptoms or admissions without a survival benefit. Verapamil and class I antiarrhythmics are harmful in HFrEF.

Option by option

  • A. Verapamil and flecainide

    Verapamil is negatively inotropic and flecainide is proarrhythmic.

  • B. Digoxin, loop diuretics and nitrates

    Digoxin and loop diuretics give symptom benefit only.

  • C. Amlodipine and thiazides

    Amlodipine is neutral and thiazides are not a survival therapy.

  • D. ARNI or ACE inhibitor, evidence-based beta blocker, MRA and SGLT2 inhibitor (correct)

    Correct. These are the four pillars with proven mortality benefit.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, ARNI or ACE inhibitor, evidence-based beta blocker, MRA and SGLT2 inhibitor. The four pillars of HFrEF therapy are ACE inhibitor or ARNI, bisoprolol, carvedilol or metoprolol succinate, mineralocorticoid antagonist and SGLT2 inhibitor.

Why is "Verapamil and flecainide" not the answer?

Verapamil is negatively inotropic and flecainide is proarrhythmic.

Why is "Digoxin, loop diuretics and nitrates" not the answer?

Digoxin and loop diuretics give symptom benefit only.

Why is "Amlodipine and thiazides" not the answer?

Amlodipine is neutral and thiazides are not a survival therapy.

What concept does this question test?

It tests Cardiology: survival drugs in HFrEF in General Medicine. Loop diuretics and digoxin relieve symptoms or admissions without a survival benefit. Verapamil and class I antiarrhythmics are harmful in HFrEF.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: survival drugs in HFrEF?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.