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 looks swollen. 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?

Options

Diltiazem
Propranolol
Esmolol
Propylthiouracil

Correct Answer

Diltiazem

Explanation

This patient has thyroid storm with atrial fibrillation. The question tests knowledge of rate control in AF with contraindications. Analysis: 1) Patient has bronchial asthma → β-blockers (propranolol, esmolol) are CONTRAINDICATED (can cause bronchospasm), 2) Propylthiouracil treats hyperthyroidism but does not provide immediate rate control, 3) Diltiazem (calcium channel blocker) is the correct choice for rate control in AF when β-blockers are contraindicated. It provides: immediate heart rate control, no bronchospasm risk, useful in thyrotoxic AF. Additional management would include antithyroid drugs, corticosteroids, and supportive care.

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