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?: (A) Esmolol, (B) Ibultilide, (C) Digoxin, (D) DC Shock 25-50J
Answer is D. 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