A 42-year-old man with prior myocardial infarction presents with asymptomatic ventricular bigeminy on Holter monitoring. Vital signs: BP 118/76 mmHg, HR 72 bpm, RR 16, temp 37°C, SpO2 98% on room air. Transthoracic echocardiography shows ejection fraction of 28%. He denies syncope or palpitations. Current medications include lisinopril, metoprolol, and atorvastatin. Which of the following is the most appropriate management?
- A)Add amiodarone for PVC suppression
- B)Start procainamide for suppression of premature ventricular contractions
- C)Start sotalol to improve ejection fraction
- D)Implant a pacemaker immediately
- E)Continue current medications; no antiarrhythmic therapy indicatedGABARITO
Explicação
In patients with reduced ejection fraction post-MI, asymptomatic PVCs (even bigeminy) do not require antiarrhythmic therapy. The CAST trial showed that Class IC antiarrhythmics and other drugs that suppress PVCs increase mortality in this population. Optimal m... Ver explicação completa e trilha adaptativa →