A. When the heart rate remains elevated and beta-blockers are contraindicated (i.e. asthmatic) with normal left ventricular systolic function
B. When atrial fibrillation is present during a ST elevation myocardial infarction, an ejection fraction of 30%, and elevated heart rates
C. When hypertension is uncontrolled after an inferior ST elevation myocardial infarction and an ejection fraction of 25%.
D. Non-dihydropyridine calcium channel blockers are not indicated during ST segment elevation myocardial infarctions
The non-dihydropyridine calcium channel blockers diltiazem and verapamil can be used when there is a contraindication to beta-blockers (such as asthma) and there is no heart failure or significant left ventricular systolic dysfunction present. They are especially helpful to lower heart rate and reduce oxygen demand in this situation. Sublingual nifedipine is contraindicated due to a reflexive increase in the sympathetic nervous system which can be harmful.