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MRCP Part 1Cardiology
1:24

A 62-year-old patient presents with breathlessness and ankle oedema. ECG shows broad QRS with notched R waves in V5–V6. Echo reveals an LVEF of 30%. Most appropriate next step?

AOptimise loop diuretic and review in 6 weeks
BRefer for cardiac resynchronisation therapy (CRT)
CCoronary angiography with a view to revascularisation
DCardiac MRI to assess for fibrosis
Teaching Point
Meets ESC / SA Heart Association criteria for CRT, LVEF ≤ 35%, NYHA II–IV symptoms, and QRS ≥ 130 ms with LBBB morphology. Optimising medical therapy alone is unlikely to be sufficient given the QRS prolongation indicates electrical dyssynchrony.
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