Pt has new diagnosed HFrEF and asks, "In addition to furosemide, what is the most appropriate pharmacotherapy?
A: "Lisinopril"
A wrong answer choice was "Metoprolol"
Explanation states it is better to start with diuretics and ACE inhibitor, then add a beta-blocker if HFrEF persists. The most important factor is to stabilize volume status before adding BB.
"underlying cause of the patient's heart failure is not known, initial pharmacotherapy should prioritize volume and blood pressure management. In addition to furosemide, the initiation of lisinopril is most appropriate at this time. Once the patient's volume status has been optimized, a repeat echocardiography may be performed to assess for the potential recovery of EF and inform further management decisions."
Current format makes these cards seem like both are equally "first line" and "either or" not "add both"
This edit helps explain when to add the BB
Worth noting, AMBOSS says:
"Beta blocker PLUS either an ACEI or ARB" (but this is specifically referring to long-term management), see Acute HF and BB links in comments
https://next.amboss.com/us/article/rS0faf?q=HFrEF#Ya1c99551cf3cd9e632d2e79b9b2c3f72
Source: Other - NBME CCSSA form 11