Implantable Cardioverter–Defibrillators in Nonischemic Cardi
Mr. Gregory is a 68-year-old man with nonischemic cardiomyopathy who has come to your office to discuss possible placement of an implantable cardioverter–defibrillator (ICD). Six months ago, he was admitted to the hospital with progressive exercise intolerance and new onset of edema in his legs. He has a history of heavy alcohol use but has been abstinent for the past 5 years. During his hospital stay, an echocardiogram showed an ejection fraction of 30%; cardiac catheterization revealed no clinically significant coronary artery disease. He received a diagnosis of nonischemic cardiomyopathy, which was presumed to be due to alcohol use. At discharge, medical therapy was prescribed that included lisinopril (20 mg daily), carvedilol (25 mg twice daily), spironolactone (25 mg daily), and furosemide (20 mg daily)....