A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 45-year-old man with no significant past medical history presents with palpitations that started 3 days ago. He denies chest pain, shortness of breath, or syncope. His blood pressure is 130/85 mmHg, heart rate is 140/min, and ECG shows atrial fibrillation with a rapid ventricular response. Which of the following is the most appropriate initial pharmacologic management?
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A
Carvedilol administrationIncorrect. Carvedilol can rate-control but diltiazem has more predictable rapid IV onset for acute AF with RVR.
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B
Diltiazem administrationCorrect. Diltiazem provides rapid AV nodal blockade for ventricular rate control in acute AF with RVR.
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C
Amiodarone administrationIncorrect. Amiodarone is for rhythm control or refractory cases, not first-line acute rate control.
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D
Ibutilide administrationIncorrect. Ibutilide is for chemical cardioversion, not initial rate control in stable AF.
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E
Adenosine administrationIncorrect. Adenosine works on AVNRT/AVRT and does not provide sustained rate control in AF.
↑ Tap an answer to reveal the reasoning
Answer: B. In managing atrial fibrillation with rapid ventricular response, rate control is often prioritized initially. Diltiazem, a calcium channel blocker, is effective for this purpose. Beta-blockers like carvedilol (choice B) are also used for rate control but in this vignette, diltiazem is more appropriate given its rapid action in acute settings. Amiodarone (choice A) is more for rhythm control.