ACE and hydrops fetalis: Heart failure (HF) with reduced ejection fraction (HFrEF) is a prevalent condition with an overall poor prognosis.[1] The combination of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) plus a beta-blocker (BB) is first-line therapy for HFrEF management,[1],[2] as these medications reduce morbidity and mortality compared to placebo.[3],[4],[5] These results have led guideline authors to universally recommend starting these agents in most patients with (HFrEF).[1],[2]