What is the first-line treatment for congestive heart failure?

• A. Beta-blockers
• B. ACE inhibitors or ARBs
• C. Calcium channel blockers
• D. Diuretics

Answer: (D)

Relieving fluid overload is the immediate priority in congestive heart failure. Diuretics quickly lower preload by promoting salt and water loss, which reduces venous congestion, edema, and pulmonary edema, and thus improves shortness of breath and overall symptoms. Loop diuretics such as furosemide are commonly used for rapid diuresis and can be titrated to achieve euvolemia while watching electrolytes and kidney function.

While other therapies like ACE inhibitors or ARBs and beta-blockers are crucial for long-term outcomes and remodeling in chronic systolic heart failure, they don’t provide the rapid symptom relief that diuretics offer and require careful initiation and titration after stabilization. Calcium channel blockers are not preferred as first-line in heart failure with reduced ejection fraction because some can worsen cardiac function or are not effective for symptom relief. So, addressing volume overload with a diuretic is the best initial step.