🏥 USMLE Exam Prep

A 68-year-old man with NYHA Class III heart failure despite optimal medical therapy (beta-blocker, ACE inhibitor, spironolactone) presents for follow-up. His LVEF is 30%, and ECG shows a QRS duration of 160 ms. His creatinine is stable at 1.2 mg/dL, and potassium is 4.5 mEq/L. Which of the following interventions should be considered next to improve mortality?

A Digoxin
B Ivabradine
C Cardiac resynchronization therapy (CRT)
D Hydralazine/isosorbide dinitrate

✓ Correct Answer: Option C

CRT is indicated for symptomatic heart failure patients (NYHA Class II-IV) with LVEF ≤35%, sinus rhythm, and a wide QRS duration (≥150 ms, or 120-149 ms with specific morphology) despite optimal medical therapy, to reduce mortality and morbidity.

Related USMLE Exam Prep Questions