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Heart Failure — RACP Adult Medicine MCQ

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ModerateCardiologyHeart FailureRACP Adult Medicine

A 65-year-old man with ischaemic cardiomyopathy (LVEF 30%) and NYHA class II heart failure is on optimal medical therapy including an ACE inhibitor, carvedilol, and spironolactone. His QRS duration is 155 ms with LBBB morphology. Which intervention is most likely to reduce mortality?

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Correct answer: C — Cardiac resynchronisation therapy with defibrillator (CRT-D)

CRT-D is recommended for patients with HFrEF (LVEF ≤35%), NYHA class II–IV symptoms despite optimal medical therapy, sinus rhythm, and QRS ≥150 ms with LBBB morphology. It reduces mortality and improves symptoms. The benefit is greatest in LBBB with QRS ≥150 ms.

Reference: NHF/CSANZ – 2018 – Guidelines for the Prevention, Detection and Management of Heart Failure in Australia