What is an appropriate EF cutoff for AICD placement for this patient?
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First you need to exclude CAD as a primary cause of the cardiomyopathy. This usually involves a heart cath to rule out obstructive coronary artery disease. If obstructive coronary artery disease is present, it should be treated with intervention if applicable. If no significant coronary artery disease is present, nonischemic etiologies need to be evaluated. I would refer to this guideline: 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
Second, maximum medical therapy for heart failure should be applied as per the ACC/AHA heart failure guidelines noted above. An echocardiogram can then be rechecked to reevaluate LVEF on maximal medical therapy. Also reassess NYHA classification.
Then follow this guideline (2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.): page 69 or 80 depending on ischemic vs nonischemic etiology.
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