Case-Based Modules > Case 22

It's possible that he might need IV metoprolol. That would certainly bring his HR down if a sufficient dose is given. But would it be safe to do so? We have to keep in mind that metoprolol is a beta-blocker, and with that, comes negative inotropy. Cardiac output is also a function of stroke volume and heart rate; can the patient afford to have his heart rate get lowered? There's one more piece of information we need to check first, almost reflexively after finding out someone is in a-fib with RVR. (Also worth nothing that he has HFpEF. We also should've checked to see if he has clinical signs and symptoms of acute decompensation, and if so, beta-blockade would be a terrible idea.)

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