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3 years ago

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

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