Which medication is most appropriate to prevent heart failure symptoms in a patient with a prior myocardial infarction and an ejection fraction of 38%?

• A. Amlodipine (Norvasc)
• B. Furosemide (Lasix)
• C. Hydrochlorothiazide (HCTZ)
• D. Lisinopril (Zestril)

Answer: (D)

The key idea is that after a myocardial infarction with reduced ejection fraction, preventing remodeling and neurohormonal activation improves survival and reduces progression to heart failure. An ACE inhibitor accomplishes this by blocking the renin-angiotensin-aldosterone system, which lowers afterload, mitigates adverse cardiac remodeling, and decreases mortality. Lisinopril, as an ACE inhibitor, is the best choice to prevent heart failure symptoms in this scenario because it directly targets these mechanisms.

Calcium channel blockers like amlodipine don’t provide mortality or remodeling benefits in this post-MI, LV-dysfunction context. Diuretics such as furosemide or hydrochlorothiazide help with fluid symptoms but do not prevent disease progression or improve long-term outcomes.