Cardiology: primary prevention ICD: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: primary prevention ICD

Sample item

A 62-year-old man had an anterior myocardial infarction 6 months ago. On optimal ACE inhibitor, beta-blocker and spironolactone he is in NYHA class II. Echocardiography shows an ejection fraction of 28%, and the ECG shows sinus rhythm with a QRS of 100 ms. No ventricular arrhythmia has been documented. Which additional therapy reduces his risk of sudden death?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Implantable cardioverter-defibrillator

An implantable defibrillator is indicated for primary prevention in ischaemic cardiomyopathy with ejection fraction at or below 35% and symptoms despite at least 3 months of optimal drugs, with more than 40 days after infarction. Resynchronisation needs a wide QRS, and amiodarone does not improve survival.

Option by option

  • A. Cardiac resynchronisation pacemaker

    Resynchronisation therapy helps when the QRS is wide with dyssynchrony, and his QRS is narrow.

  • B. Long-term prophylactic amiodarone

    Prophylactic amiodarone has not been shown to reduce mortality in this setting.

  • C. Ivabradine added to therapy

    Ivabradine lowers heart rate and admissions but does not prevent sudden arrhythmic death.

  • D. Implantable cardioverter-defibrillator (correct)

    Correct. Persistent ejection fraction of 35% or less on optimal therapy is the criterion for a primary-prevention defibrillator.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Implantable cardioverter-defibrillator. An implantable defibrillator is indicated for primary prevention in ischaemic cardiomyopathy with ejection fraction at or below 35% and symptoms despite at least 3 months of optimal drugs, with more than 40 days after infarction.

Why is "Cardiac resynchronisation pacemaker" not the answer?

Resynchronisation therapy helps when the QRS is wide with dyssynchrony, and his QRS is narrow.

Why is "Long-term prophylactic amiodarone" not the answer?

Prophylactic amiodarone has not been shown to reduce mortality in this setting.

Why is "Ivabradine added to therapy" not the answer?

Ivabradine lowers heart rate and admissions but does not prevent sudden arrhythmic death.

What concept does this question test?

It tests Cardiology: primary prevention ICD in General Medicine. Resynchronisation needs a wide QRS, and amiodarone does not improve survival.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: primary prevention ICD?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.