A 55 year old man with known heart failure and LVEF of 37% is reviewed in the outpatient clinic with breathlessness. He is NYHA class III with no signs of fluid overload on examination. His BP is 110/60 mmHg, and his heart rate is 55 bpm. He is on bisoprolol 5 mg od and ramipril 10 mg od.
His U&E tests reveal:
Which one of the following medications will you chose next?A) Furosemide 40 mg od
A mineralocorticoid receptor antagonist (MRA) (spironolactone or epleronone) is the next choice of medication in patients with chronic symptomatic systolic heart failure (NYHA functional class II–IV) established on optimal ACE inhibitor and beta-blocker (BB). An angiotensin receptor blocker (ARB) is an alternative if an MRA is not tolerated. No indication for furosemide as the patient is not fluid overloaded.