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Secondary prevention after myocardial infarction — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Secondary prevention after myocardial infarctionUSMLE Step 3

A 60-year-old is 45 days after an anterior myocardial infarction. Despite maximally tolerated guideline-directed therapy, LVEF is 30% and NYHA class II symptoms persist. There has been no sustained ventricular arrhythmia. What is the best next step for sudden-death prevention?

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Correct answer: C — Refer for primary-prevention implantable cardioverter-defibrillator assessment

Explanation lettering: D = shown as A · A = shown as C · E = shown as D · C = shown as E

The post-MI interval, persistently reduced LVEF and symptoms meet criteria for primary-prevention ICD assessment. B omits key eligibility review. C is not mortality-preventive in structural heart disease. D and E misuse bridge or timing strategies.

Reference: ACC/AHA/HFSA, Heart Failure Guideline: https://www.acc.org/Guidelines