Which class of medications is generally contraindicated in congestive heart failure?

• A. NSAIDs
• B. Acetaminophen
• C. Statins
• D. Antihistamines

Answer: (A)

NSAIDs are especially problematic in congestive heart failure because they interfere with the kidneys’ ability to regulate fluid and salt balance, which can worsen edema and heart failure symptoms. They block prostaglandins, reducing afferent arteriolar dilation, which lowers renal perfusion and glomerular filtration rate. This promotes sodium and water retention, increasing preload and fluid overload, and can blunt the effects of diuretics and other heart-failure medications. In a patient with CHF, this combination can precipitate decompensation and hospitalization. For pain, acetaminophen is generally preferred because it does not have the same impact on renal perfusion or fluid status. Statins and antihistamines don’t carry the same risk of worsening heart failure through fluid retention or renal effects, so they’re not contraindicated in the same way.