Question

A female patient presents to the emergency department with severe restlessness, palpitations, and tremors. She is a known case of bronchial asthma. On examination, the neck looksswollen. Blood pressure is elevated, and tachycardia is noted. ECG shows atrial fibrillation.Which of the following drugs is used for immediate management in this patient?

• A. Diltiazem
• B. Propranolol
• C. Esmolol
• D. Propylthiouracil

Answer 1

The Correct Option is A

A female patient with symptoms of restlessness, palpitations, and tremors, combined with a known case of bronchial asthma, presents a clinical challenge. The swollen neck hints at possible underlying thyroid dysfunction, potentially leading to a condition like thyrotoxicosis, which can precipitate atrial fibrillation. These signs warrant immediate management to stabilize her condition. The main concern is to manage the tachycardia and atrial fibrillation effectively while considering her asthma.

1. Patient's Symptoms: Severe restlessness, palpitations, tremors, swollen neck, elevated blood pressure, tachycardia, atrial fibrillation.
2. Diagnosis Consideration: The symptoms and neck swelling suggest thyrotoxicosis, likely leading to atrial fibrillation. Management of the heart rate is crucial.
3. Drug Selection Rationale:

• Esmolol: A beta-blocker, rapid effect but non-selective. May not be best due to asthmatic condition.
• Propranolol: A non-selective beta-blocker is contraindicated in asthma.
• Diltiazem: A calcium channel blocker, effective for rate control in atrial fibrillation, safe for asthmatics.
• Propylthiouracil: Used for thyroid control, not immediate rate control.

4. Conclusion: Diltiazem is the drug of choice here as it controls the heart rate in atrial fibrillation and is safe for asthma patients.