A 62-year-old man with a history of an anterior STEMI 45 days ago has a left ventricular ejection fraction of 30 percent on echocardiogram. He is on optimal medical therapy including beta-blockers and ACE inhibitors. He has no history of cardiac arrest or sustained ventricular tachycardia. According to current guidelines, which is the most appropriate next step in management?
- A Electrophysiology study with programmed ventricular stimulation
- B Implantation of a cardioverter-defibrillator (ICD) ✓
- C Addition of amiodarone
- D Cardiac resynchronization therapy (CRT)
Correct answer: B. Implantation of a cardioverter-defibrillator (ICD)
Explanation
Primary prevention ICD is indicated in patients with ischemic cardiomyopathy, LVEF ≤35 percent, at least 40 days post-MI, and on optimal medical therapy. EP study is not routinely indicated for primary prevention. Amiodarone does not reduce mortality compared to ICD. CRT is indicated for wider QRS complexes.
Reference: Braunwald's Heart Disease, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.