American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended action for a patient with previous myocardial infarction and low ejection fraction?

1. Continued observation

2. Consideration of ICD placement

3. Immediate surgical intervention

4. Only lifestyle modifications

The correct answer is: Consideration of ICD placement

For a patient with a history of myocardial infarction and low ejection fraction, the recommended action is the consideration of implantable cardioverter-defibrillator (ICD) placement. Patients in this scenario are at a heightened risk of life-threatening ventricular arrhythmias due to their compromised cardiac function. The guidelines suggest that patients with a reduced left ventricular ejection fraction (typically less than 35%) who have a history of heart failure or myocardial infarction are at significant risk for sudden cardiac death, and an ICD can provide life-saving interventions. The ICD is designed to monitor the heart's rhythm and deliver shocks when it detects dangerous arrhythmias, significantly reducing mortality rates among these individuals. Therefore, in the context of secondary prevention, ICD placement plays a crucial role in the management of patients who have already experienced a myocardial infarction and have a low ejection fraction. Other options such as continued observation, immediate surgical intervention, or solely relying on lifestyle modifications do not address the immediate risk of arrhythmias in such patients and do not comply with current cardiology guidelines that advocate for proactive management through devices like the ICD.