75 year old lady with ischemic cardiomyopathy , symptomatic systolic CHF interested in cardiac resynchronization therapy
By Medcase Editor - MD | Mar 1, 2021
A 75-year-old woman has history of STEMI 3 years ago . She had a cardiac cath at that time and underwent stent placement- Echo showed a ejection fraction of 20 % at that time. She underwent a cardioverter-defibrillator for sudden cardiac arrest prophylaxis. She is now having worsening DOE and 3 pillow orthopnea – NYHA CLASS 3. She recently read an online health article about cardiac resynchronization therapy . During her office visit, she wanted to know if she would suitable candidate for CRT and wondered if may improve her symptoms and functional capacity- . Her current medications are losartan 25 mg daily, metoprolol XL 25 mg daily , spironolactone 25 mg daily, and bumex 2 mg daily. Physical examination- Vital signs – HR 65 : BP 122/70 mm Hg, no JVD, lungs clear, no edema, cardiac impulse displaced to left, Positive S3, no murmurs; EKG showed left bundle branch block (LBBB) with QRS duration of 160 ms, and TTE showed ejection fraction (LVEF) of 10%. What is the most appropriate next step in management for this patient ?
Explanation:
HR is 65, BP is well controlled with no edema – on maximal tolerated medical treatment – no further titration of medications needed
CRT is indicated for patients congestive heart failure symptoms with NYHA class III or IV
CRT is indicated for patients who have LBBB with QRS duration of more than 120 ms
CRT is indicated for patients who have LVEF less than 35%, LBBB with QRS duration of more than 120 ms, and congestive heart failure in NYHA class III or IV despite receiving the maximally tolerated medical therapy
