A 76-year-old with LVEF 25% and atrial fibrillation at 146/min is dyspneic but has warm extremities, BP 108/66 mmHg and no pulmonary edema. He takes

Question

A 76-year-old with LVEF 25% and atrial fibrillation at 146/min is dyspneic but has warm extremities, BP 108/66 mmHg and no pulmonary edema. He takes maximally tolerated carvedilol. Which acute rate-control option is most appropriate?

Accepted Answer

Give intravenous digoxin for rate control while monitoring perfusion

Answer

Give intravenous verapamil because severe LV dysfunction increases its rate-control benefit

Answer

Begin intravenous diltiazem because it rapidly lowers ventricular rate

Answer

Perform immediate cardioversion because the ventricular rate is above 140/min

Answer

Escalate carvedilol orally every hour until ventricular rate is below 90/min

Atrial Fibrillation (Rate Control in HFrEF) — ABIM Board MCQ

A 76-year-old with LVEF 25% and atrial fibrillation at 146/min is dyspneic but has warm extremities, BP 108/66 mmHg and no pulmonary edema. He takes maximally tolerated carvedilol. Which acute rate-control option is most appropriate?