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Heart Failure (HFrEF) — EECC MCQ

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HardCardiologyHeart Failure (HFrEF)EECC

A patient with hypertrophic cardiomyopathy has maximal wall thickness 19 mm, an apical aneurysm with transmural scar, and recurrent non-sustained VT. The calculated five-year HCM sudden-death risk is 3.5%. What is the best interpretation?

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Correct answer: D — Individual ICD assessment using the aneurysm and scar burden

Risk calculators inform but do not replace individual assessment. An LV apical aneurysm, extensive late gadolinium enhancement and clinically significant ventricular arrhythmia can materially modify risk even when the numerical estimate is below a conventional threshold. Shared ICD decision-making should incorporate competing mortality, device complications and the complete phenotype. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: 2023 ESC Guidelines for cardiomyopathies. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/cardiomyopathy/