The Correct Answer is D!

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Question:

A 28 year-old woman has had a prior peripartum cardiomyopathy two years ago, now treated with an ACE inhibitor and beta blockers. Her EF has recovered to 40% and was told to not have another pregnancy. However, she now returns 8 weeks pregnant. Examination shows normal JVP and trace pedal edema.

Which of the following medications would be appropriate to utilize?

  1. Angiotensin II receptor blocker
  2. Loop diuretic
  3. ACE inhibitor
  4. Metoprolol

Answer Rationale:

There is no drug that is completely safe during pregnancy. However, both ACE inhibitors and angiotensin II receptor blockers are contraindicated due to a high fetal mortality from fetal renal tubular dysplasia, oligohydramnios, and increased risk of CV and CNS malformations. Aldosterone antagonists have an antiandrogenic effect during the first trimester. Beta blockers may result in intrauterine growth retardation but may be used cautiously during pregnancy if necessary.

1.  Source: "Comparative Analysis of Pre/Post Assessments of Live/Didactic Course Attendees when compared to Mico-Learning/Online Course Users., "Knowledge to Practice, 2017.