Which of the following drugs should be avoided in a pregnant female with dilated cardiomyopathy?
**Core Concept**
Dilated cardiomyopathy is a condition where the heart's ability to pump blood is impaired due to a weakening of the heart muscle. In pregnancy, the cardiac workload increases, and managing the condition requires careful consideration of medication to prevent complications.
**Why the Correct Answer is Right**
In pregnancy, ACE inhibitors (e.g., **lisinopril**) are generally avoided due to their potential to cause fetal renal damage and oligohydramnios (reduced amniotic fluid levels). The mechanism involves the inhibition of angiotensin-converting enzyme (ACE), which leads to decreased production of angiotensin II, a potent vasoconstrictor. This can compromise placental perfusion and fetal development.
**Why Each Wrong Option is Incorrect**
**Option A:** Digoxin is often used in heart failure to increase the contractility of the heart muscle. It is not typically associated with fetal harm and can be continued during pregnancy.
**Option B:** Beta-blockers, such as **metoprolol**, are commonly used in heart failure and are generally considered safe during pregnancy.
**Option C:** Diuretics, such as **furosemide**, are used to manage fluid overload in heart failure and are not typically contraindicated in pregnancy.
**Clinical Pearl / High-Yield Fact**
ACE inhibitors should be discontinued at least 6 weeks prior to conception or as soon as pregnancy is diagnosed to minimize the risk of fetal harm.
**Correct Answer:** C. Furosemide is generally safe during pregnancy and can be used in a pregnant female with dilated cardiomyopathy.