A 62-year-old man with a history of diabetes mellitus, hypertension, and congestive heart failure (CHF) presents with progressive bilateral lower extremity swelling, orthopnea, and paroxysmal nocturnal dyspnea. His brain natriuretic peptide (BNP) level is 1200 pg/mL. His creatinine is 1.8 mg/dL (baseline 1.1 mg/dL), and he has peripheral edema. Which medication should be initiated or up-titrated for acute symptom relief and management of his CHF exacerbation?
✓ Correct Answer: Option C
This patient has an acute decompensated heart failure exacerbation with volume overload (edema, orthopnea, elevated BNP, weight gain). Furosemide (a loop diuretic) is crucial for acute symptom relief by reducing preload and alleviating congestion. Beta-blockers and ACE inhibitors are for chronic management and may be contraindicated or need to be held during acute decompensation.