Diltiazem

I would say, "Hey, maybe you wanna take a probiotic, uh, with that, uh, because, you know, these antibiotics, they can kill, they can kill the good bacteria.

You may wanna take a probiotic." Or, uh, they would come in for, uh, their, their, um, [lips smack] uh, Cardizem.

Nife- uh, Card- what is Cardizem? Or nifedipine, verapamil, or whatever the heck they were gonna take.

A calcium channel blocker.

I said, "You know what? Take some magnesium with that.

It is not an acute agent.

Verapamil and Diltiazem.

Effective rate control but negatively inotropic.

Hazardous with impaired ventricular function and more so if beta blockade is already on board.

I usually

start with nifedipine and then go to diltiazem.

Diltiazem, yeah.

Usually it's my second choice.

Yes.

The echocardiogram went right into heart cath and went right to me being sent to St. Louis to start trying to find a treatment, and there were no real treatments for it.

They tried Cardizem and different drugs they had.

But Flolan was an upcoming drug that had been in studies for a couple years, but it was the first drug that was actually made for the treatment of pulmonary hypertension.

I got on the tail end of that study, and it saved my life.

The review specifically suggests pushing Metaprol of 5 mg intravenously every 5 minutes for a total of 3 doses.

If the patient has severe reactive airway disease or COPD where a beta blocker might trigger a bronchospasm, you might choose a calcium channel blocker like Diltiazem instead.

You can also try loading them with imiodarone combined with low molecular weight heparin to attempt chemical cardioversion.

If they remain rapid and refractory to all medications, then you proceed to electrical cardioversion.