A 62-year-old with HFrEF and new-onset atrial fibrillation needs rate control. Which calcium channel blocker is contraindicated in this setting?
- A Diltiazem ✓
- B Nifedipine
- C Amlodipine
- D Nicardipine
Correct answer: A. Diltiazem
Explanation
Non-dihydropyridine agents, verapamil and diltiazem, depress sinoatrial and atrioventricular nodal conduction and have negative inotropic effects, worsening systolic dysfunction and precipitating decompensation in HFrEF. Diltiazem is therefore contraindicated for rate control in this patient. The dihydropyridines listed are vascular-selective, cause reflex tachycardia rather than nodal slowing, and are relatively safe for left ventricular function, though they do not control ventricular rate.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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