Case-Based Modules > Case 24

Sorry! There are two problems with this answer choice. One, while we generally don't consider metoprolol as having potent antihypertensive effect, in this acute situation with this degree of hypotension, it's prudent to avoid it. Two, generally speaking, a-fib isn't the cause for an acute hemodynamic decline unless the RVR reaches a HR of ≥ 150. (Exceptions include if they have concomitant mitral valve disease, which makes them more dependent on that atrial kick for diastolic filling.) With this patient's HR being between 110s-120s, there's no reason to try to reduce the HR. Actually, doing so could be harmful, as cardiac output is dependent on HR. Here, she may be experiencing an acute illness for which she needs a compensatory higher HR.

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