My father has acute heart failure and extensive MI since two months ago. Also, he got a pleural effusion and leg edema. He is in bed symptomatic depending on oxygen device most of the time. His EF is 21.
The ECG shows possible left atrial enlargement, nonspecific intraventricular block, right ventricular hypertrophy, inferior infarct, and anterolateral infarct. QRS = 138 with right bundle branch block.
He sleeps in a 30-45 degree. We did not do PCI until now. I would like to know will CRTD be good for him?
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As he had a heart attack, first priority is revascularization of angioplasty or bypass surgery. If this is done and heart function improves, then it will be good. In right bundle branch block, there is very little benefit of CRT (cardiac resynchronization therapy).
If revascularization is not possible, then maximum medical therapy is best. Yes, ICD (implantable cadioverter defibrillator) is indicated. It should be considered once the patient is out of the acute episode and is stabilized.
If the patient needs recurrent hospitalization for heart failure or recurrent BP drops that need medicines to raise it, then the option is left ventricular assist device (LVAD) or total artificial heart (TAH) or heart transplantation (subject to availability of facilities).
First thing is to assess for revascularization if there is viable heart muscle.
I hope this helps.
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