RT Book, Section
A1 Kahwash, Rami
A2 Baliga, R. R.
A2 Abraham, William T.
SR Print(0)
ID 1161018357
T1 Cardiac Cardioverter Defibrillators (ICDs) in Heart Failure
T2 Color Atlas and Synopsis of Heart Failure
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071749381
LK accesscardiology.mhmedical.com/content.aspx?aid=1161018357
RD 2024/04/20
AB A  55-year-old  man  with  past  medical  history  significant  for  hypertension  (HTN),  hyperlipidemia,  and  type  2  diabetes  mellitus,  was  admitted  to  the  coronary  care  unit  3  months  ago  with  non-ST-elevation  myocardial  infarction  (NSTEMI).  Coronary  angiography  then  revealed  95%  narrowing  in  the  proximal  left  anterior  descending  coronary  artery.  He  underwent  successful  percutaneous  coronary  intervention  and  stent  placement  with  excellent  angiographic  results  and  resolution  of  his  symptoms.  His  left  ventricular  ejection  fraction  (LVEF)  was  25%  by  left  ventriculography  performed  at  the  time  of  the  intervention.  He  was  established  on  dual  antiplatelet  therapy,  statin,  and  guideline-directed  medical  therapy  for  heart  failure  (HF).  Beta  blocker  and  angiotensin-converting  enzyme  (ACE)  inhibitor  were  gradually  titrated  to  the  maximally  tolerated  doses  during  the  next  few  months  after  discharge.  He  returned  for  his  3-month  post  discharge  visit  reporting  no  angina.  An  echocardiogram  in  the  office  revealed  an  LVEF  of  30%.  His  12-lead  electrocardiogram  (ECG)  showed  normal  sinus  rhythm  (NSR),  normal  intervals,  old  septal  infarct,  and  QRS  of  110  ms.  His  medications  include  carvedilol  25  mg  by  mouth  twice  daily,  lisinopril  10  mg  by  mouth  twice  daily,  spironolactone  25  mg  by  mouth  once  a  day,  aspirin  81  mg  by  mouth  once  a  day,  clopidogril  75  mg  by  mouth  once  a  day,  and  atorvastatin  80  mg  by  mouth  before  bed.  He  resides  in  NYHA  functional  class  II.  What  is  the  single  most  important  therapy  you  recommend  to  improve  his  survival?