In managing a patient with advanced aortic stenosis and reduced ejection fraction, which medication should be avoided to maintain hemodynamic stability?

In the management of a patient with advanced aortic stenosis and reduced ejection fraction, it is critical to maintain hemodynamic stability to avoid exacerbating heart failure symptoms and ensuring adequate cardiac output. Furosemide, a loop diuretic, is useful for managing fluid overload, but its use can lead to significant volume depletion. In patients with aortic stenosis, who often rely on preload to maintain adequate stroke volume, loss of volume can further compromise cardiac output and lead to worsening hemodynamic status.

This effect is particularly concerning in cases of advanced aortic stenosis, where the heart is already struggling to maintain adequate perfusion. Decreased preload can lead to hypotension and worsening of heart failure symptoms, making furosemide a less suitable choice in this context.

The other medications, such as hydrochlorothiazide, amlodipine, and spironolactone, do have potential uses in managing hypertension or fluid status, but they generally have less immediate impact on preload and can be used more cautiously. Therefore, avoiding furosemide in this scenario is critical to maintaining hemodynamic stability in patients with advanced aortic stenosis and reduced ejection fraction.