Guideline-directed medical therapy with an indication in the European Society of Cardiology (ESC) guidelines for patients with HF with reduced ejection fraction (HFrEF) include a sodium-glucose transporter inhibitor (SGLT2i), an angiotensin receptor/neprilysin inhibitor (ARNI), an ACE inhibitor, a mineralocorticoid receptor antagonist (MRA), and beta-blockers.1 The 2023 Focused Update on the HF guideline also recommends a SGLT2i for HF with preserved ejection fraction.2 Here, ACE is linked to hydrops fetalis.