American Board of Internal Medicine (ABIM) Certification Practice Exam

What are the criteria for ICD implantation in patients with ischemic cardiomyopathy?

1. Nonsustained ventricular tachycardia

2. FEV1 ≤ 50% of predicted

3. HEMODYNAMICALLY significant ventricular arrhythmia and ejection fraction ≤ 35%

4. Symptomatic heart failure with no risk factors

The correct answer is: HEMODYNAMICALLY significant ventricular arrhythmia and ejection fraction ≤ 35%

The criteria for implantable cardioverter-defibrillator (ICD) implantation in patients with ischemic cardiomyopathy primarily focus on reducing the risk of sudden cardiac death in individuals who have severe left ventricular dysfunction. The correct answer highlights that the presence of hemodynamically significant ventricular arrhythmia, in conjunction with an ejection fraction of 35% or less, is a crucial indication for ICD placement. Patients with ischemic cardiomyopathy often suffer from compromised ventricular function due to previous myocardial infarctions or chronic ischemia. The ejection fraction is a key measure in cardiology, reflecting how effectively the heart pumps blood. When the ejection fraction falls to 35% or below, it signifies significant heart dysfunction, which elevates the risk for life-threatening arrhythmias. The presence of hemodynamically significant ventricular arrhythmias, which can lead to syncope or sudden cardiac arrest, adds to this risk, thus indicating that such patients may benefit from an ICD to provide lifesaving defibrillation in case of sustained abnormal rhythms. While nonsustained ventricular tachycardia may indicate a substrate for arrhythmias, it does not alone meet the rigorous criteria needed for ICD implantation. Additionally, a FEV1 ≤ 50