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Diltiazem Contraindicated HFrEF — RACP Adult Medicine MCQ

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ModerateCardiologyDiltiazem Contraindicated HFrEFRACP Adult Medicine

A 68-year-old man with AF and HFrEF develops progressive renal impairment on high-dose diuretics. His BP drops to 90/55. ECG shows HR 35 bpm with CHB. He was recently commenced on diltiazem for rate control. What is the cause?

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Correct answer: E — Diltiazem causing CHB and haemodynamic compromise (contraindicated in HFrEF)

Diltiazem (and verapamil) are CONTRAINDICATED in HFrEF: negative inotropic effect worsens HF, and rate-slowing can cause CHB. Use digoxin or amiodarone for rate control in HFrEF with AF.

Reference: eTG – 2025 – Cardiovascular