A 68-year-old man with a history of anterior STEMI 3 years ago now presents with fatigue and dyspnea. An ECG shows LBBB. Echocardiography reveals an ejection fraction of 28% with dilated left ventricle. He is already on optimally titrated ACE inhibitor and beta-blocker. Which additional therapy has been shown to reduce all-cause mortality in this patient?
- A Ivabradine
- B Cardiac resynchronization therapy (CRT) ✓
- C Digoxin
- D Amiodarone
Explanation
Cardiac resynchronization therapy (CRT) is indicated in patients with symptomatic heart failure (EF ≤ 35%), LBBB with QRS ≥ 150 ms, who remain symptomatic despite optimal medical therapy; it reduces all-cause mortality, hospitalizations, and improves symptoms and EF. Ivabradine reduces heart-failure hospitalizations but its mortality benefit is less robust and it requires sinus rhythm; it is not the primary addition here. Digoxin reduces hospitalization but has no proven mortality benefit and carries a narrow therapeutic window. Amiodarone is an antiarrhythmic and is not used for mortality reduction in stable HFrEF.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.