American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be the initial medical therapy for peripartum cardiomyopathy?

1. Start with diuretics only

2. ACE inhibitors or angiotensin receptor blockers

3. Digoxin only

4. Calcium channel blockers

The correct answer is: ACE inhibitors or angiotensin receptor blockers

The initial medical therapy for peripartum cardiomyopathy involves the use of ACE inhibitors or angiotensin receptor blockers. This approach is selected due to the role these medications play in reducing afterload and improving cardiac function, which is crucial in managing heart failure symptoms associated with peripartum cardiomyopathy. These agents can help to mitigate the effects of volume overload and support the heart's pumping ability, providing symptomatic relief and improving outcomes. Furthermore, ACE inhibitors have shown to have long-term benefits in heart failure management, which is critical given the chronic nature of this condition. They help in remodeling the heart structure and decrease mortality rates in heart failure patients. Additionally, the choice of these agents aligns with guidelines and evidence that emphasize their use in cases of heart failure, including that which arises during or after pregnancy. The other options, while they can play a role in treating heart failure under various circumstances, do not represent the optimal first-line treatment for this specific condition. Diuretics alone may manage volume overload, but they do not address the underlying cardiac dysfunction. Digoxin may be used for rate control in atrial fibrillation or to enhance contractility in heart failure, but it is not the primary treatment indicated in peripartum cases.