If a patient's ejection fraction (EF) is less than 35%, what should be considered?

When a patient's ejection fraction (EF) drops below 35%, it indicates significant impairment in heart function and is often associated with an increased risk of life-threatening arrhythmias. In such scenarios, the consideration of an implantable cardioverter-defibrillator (ICD) placement becomes crucial. An ICD is designed to monitor heart rhythms and deliver shocks when dangerously fast rhythms occur, which can prevent sudden cardiac death.

The recommendation for ICD placement is usually based on guidelines that suggest patients with an EF of less than 35% and who have a history of heart failure are at heightened risk for arrhythmias. Therefore, implementing an ICD can serve as a preventive measure, improving overall survival rates in these patients by providing protection against sudden cardiac events.

In contrast, while beta-blockers are often prescribed in cases of heart failure, and calcium channel blockers may have limited roles in certain types of heart conditions, those therapies do not address the urgent risk of arrhythmias as effectively as an ICD does in this context. Increasing fluid intake typically does not relate to managing low EF and might lead to further complications, particularly in patients with heart failure.