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Diltiazem in reduced ejection fraction — GPhC CRA MCQ

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HardCardiovascular TherapeuticsDiltiazem in reduced ejection fractionGPhC CRA

A discharge prescription includes diltiazem for rate control in atrial fibrillation. The summary states the patient has heart failure with reduced ejection fraction and recent pulmonary oedema. What is the most appropriate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Query diltiazem because it can worsen systolic heart failure

Non-dihydropyridine calcium-channel blockers such as diltiazem and verapamil have negative inotropic effects and can worsen heart failure with reduced ejection fraction. Rate-control choices should be reviewed in light of the recent decompensation. Adding verapamil would increase the same concern. Extra salt intake would be inappropriate in heart failure.

Reference: BNF; NICE CKS