NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with new onset of atrial fibrillation with rapid ventricular response (AFib with RVR). His heart rate is 160 bpm, and he is complaining of palpitations but is otherwise hemodynamically stable. Which of the following medications is generally preferred for rate control in this patient?
- AAmiodarone
- BDiltiazem
- CAdenosine
- DMetoprolol
Show answer & explanationAnswer & explanation
Correct answer: B. Diltiazem
Diltiazem (a calcium channel blocker) is generally preferred for rate control in AFib with RVR in patients with COPD, as beta-blockers like metoprolol can exacerbate bronchospasm. The patient is hemodynamically stable, so immediate cardioversion is not indicated. Adenosine is for SVT, and amiodarone is an antiarrhythmic typically used for rhythm control or when other rate control agents are ineffective or contraindicated.
Why the other options are wrong
- A. Amiodarone is an antiarrhythmic used for rhythm control or refractory rate control, not typically first-line for stable AFib with RVR, especially with COPD concerns where diltiazem is safer.
- C. Adenosine is primarily used for narrow-complex supraventricular tachycardias, not for rate control of AFib.
- D. Metoprolol (a beta-blocker) can cause bronchospasm and is relatively contraindicated in patients with COPD.
AFib with RVR Rate Control in COPD
Managing atrial fibrillation with rapid ventricular response involves slowing the heart rate to improve symptoms and cardiac output. In patients with COPD, medication choices are crucial to avoid respiratory complications.
- Goal is to reduce ventricular rate, usually to <100 bpm.
- Calcium channel blockers (diltiazem, verapamil) are often first-line.
- Beta-blockers (metoprolol, atenolol) can exacerbate COPD.
- If unstable, immediate synchronized cardioversion is indicated.
Memory trick: Calm the heart, don't harm the lungs!