ACE and hydrops fetalis: Accordingly, all patients with HF with reduced ejection fraction, unless having a contraindication, should receive an angiotensin converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) if non tolerant to ACEi, plus a beta-blocker with the further addition of a mineralocorticoid receptor antagonist (MRA, aldosterone or eplerenone) if still symptomatic [2].