Question

What should be done in the case of Afib RVR and hypotension?

1) Administer adenosine
2) Administer β blockers
3) Administer calcium channel blockers
4) Administer digoxin

Answer 1

In the case of Afib with RVR and hypotension, adenosine, beta blockers, and calcium channel blockers are generally avoided due to the risk of exacerbating hypotension. Digoxin has a delayed effect and isn't preferred for acute management. Instead, cautious rate control and addressing underlying causes are key, with synchronized cardioversion as a potential treatment for instability.

Step-by-step explanation:

In the case of Atrial fibrillation (Afib) with Rapid Ventricular Response (RVR) and hypotension, it is generally not advised to administer adenosine or non-dihydropyridine calcium channel blockers due to the risk of further hypotension. Beta blockers can also cause exacerbation of hypotension and caution is needed. Digoxin is another option but generally is not used for acute rate control in the setting of hypotension due to its delayed onset of action and potential for worsening the condition. The immediate management might involve more cautious approaches to managing the heart rate while resolving hypotension, such as considering synchronized cardioversion if the patient is unstable, and addressing any underlying causes like electrolyte imbalances or ischemia. IV fluids or pressor agents might be used to manage the hypotension.