A 58-year-old man with ejection fraction 30% and atrial fibrillation with rapid ventricular response is being considered for a calcium channel blocker for rate control. Which agent should be avoided because it may worsen his heart failure?
- A Verapamil ✓
- B Amlodipine
- C Nifedipine
- D Nicardipine
Correct answer: A. Verapamil
Explanation
Verapamil is a nondihydropyridine that markedly depresses SA and AV nodal conduction and exerts significant negative inotropy, so it can precipitate decompensation in systolic heart failure. The dihydropyridines listed act mainly on vascular smooth muscle, have minimal cardiac depression, and are relatively safer, though they remain second line in HFrEF. Rate control in this patient should rely on beta-blockers or digoxin instead.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.