MRA

Question 1

Why are MRAs used in HF?

Answer 1

To block harmful effects of aldosterone (fluid retention, fibrosis, remodelling).

Question 2

What is “aldosterone escape”?

Answer 2

Aldosterone levels remain high despite ACEI therapy.

Question 3

How do MRAs reduce congestion?

Answer 3

By blocking aldosterone receptors → ↓ Na⁺/water retention → ↓ plasma volume → ↓ preload.

Question 4

How do MRAs improve long-term HF outcomes?

Answer 4

They reduce fibrosis, apoptosis, and cardiac remodelling.

Question 5

What are key clinical benefits of MRAs in HF?

Answer 5

Improved symptoms, reduced congestion, reduced hospitalisation, reduced mortality.

Question 6

Which HF patients should receive MRAs?

Answer 6

HFrEF, HFmrEF, and HFpEF patients unless contraindicated.

Question 7

What MRAs are licensed?

Answer 7

Spironolactone and eplerenone.

Question 8

What electrolyte disturbance can MRAs cause?

Answer 8

Hyperkalaemia (major side effect).

Question 9

What endocrine adverse effects occur with spironolactone?

Answer 9

Gynaecomastia, impotence, menstrual disturbances, hirsutism.

Question 10

Why does eplerenone cause fewer hormonal side effects than spironolactone?

Answer 10

It is more selective for aldosterone receptors.

Question 11

Why do MRAs improve survival in HF?

Answer 11

They reduce aldosterone-driven cardiac fibrosis and remodelling.