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

Begin intravenous diltiazem because it rapidly lowers ventricular rate

Answer

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

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?