Which medication is not recommended for patients with left ventricular systolic dysfunction when controlling heart rate?

Verapamil is not recommended for patients with left ventricular systolic dysfunction when controlling heart rate because it is a non-dihydropyridine calcium channel blocker that can negatively impact cardiac contractility. In patients with this condition, preserving the heart’s ability to pump efficiently is crucial, and verapamil may worsen heart failure symptoms by reducing the contractile force of the heart muscle.

In contrast, beta-blockers like metoprolol and carvedilol are beneficial for patients with left ventricular systolic dysfunction. They can improve heart function, decrease oxygen demand, and better manage heart rates without significantly impairing the heart's ability to contract. Therefore, they are often part of the standard treatment in such patients. Diltiazem, while also a non-dihydropyridine calcium channel blocker, is sometimes used more cautiously and is less contraindicated than verapamil in heart failure settings, although it is still generally avoided in severe cases.