A 62-year-old male with a history of type 2 diabetes, hypertension, and hyperlipidemia is admitted with shortness of breath and peripheral edema. His medications include metformin 1000 mg BID, lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily, and rosuvastatin 20 mg daily. On examination, he has crackles in his lungs and 3+ pitting edema in his ankles. Labwork shows elevated B-type natriuretic peptide (BNP) and an echocardiogram confirms new onset systolic heart failure. Which medication should be stopped or changed due to his new diagnosis?

Question: A 62-year-old male with a history of type 2 diabetes, hypertension, and hyperlipidemia is admitted with shortness of breath and peripheral edema. His medications include metformin 1000 mg BID, lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily, and rosuvastatin 20 mg daily. On examination, he has crackles in his lungs and 3+ pitting edema in his ankles. Labwork shows elevated B-type natriuretic peptide (BNP) and an echocardiogram confirms new onset systolic heart failure. Which medication should be stopped or changed due to his new diagnosis?

Answer options: ✅ Metformin

• Rosuvastatin
• Lisinopril
• Hydrochlorothiazide

Correct answer: Metformin

Explanation: Metformin is relatively contraindicated in patients with acute decompensated heart failure due to the increased risk of lactic acidosis. While ACE inhibitors (lisinopril) and diuretics (hydrochlorothiazide) are often used in heart failure, metformin should be temporarily discontinued in acute exacerbations.