Cardiac resynchronization therapy in the elderly heart failure patient

Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin, spironolactone, low dose beta blacker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43. She has rales, jugular venous distention and pedal edema.An II/VI pansystolic murmur is appreciated over her entire precordium and an S3 is apparent. Her electrocardiogram (ECG) is shown in Figure 1 and reveals sinus tachycardia with a prolonged QRS duration of 159 milliseconds. Her husband brings in a new article about Bi-ventricular pacing and asks you if it will help her.