This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: ECG and Arrhythmias 1, Subject name: Medicine
[{'content': 'A 40 year old man was admitted to the hospital emergency with sudden onset of symptoms and signs of severe left ventricular failure. What would be the best management of this patient? \nSelect and explain. \nA. Esmolol, B. Ibultilide, C. Digoxin, D. DC Shock 25-50J', 'role': 'user'}, {'content': 'Answer: D \nExplanation: ECG shows atrial flutter with 2:1 block. Since the patient is in acute LVF, Beta blockers are contraindicated. Since the circulation of patient is compromised, Cardioversion ( DC shock 25-50 J) is indicated. Ibutilide is used for rhythm control but at the moment prompt treatment is warranted. Digoxin is not an answer because: -It is a pro-arrythmogenic drug -Takes time to achieve therapeutic levels', 'role': 'assistant'}]