Myocardial Rupture Medication

  • Author: Jamshid Shirani, MD; Chief Editor: Eric H Yang, MD   more...
 
Updated: Dec 2, 2011
 

Medication Summary

Medications are useful to help stabilize patients who are waiting for emergency surgery.

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Inotropic Agents

Class Summary

Used in patients with VSD and free-wall rupture to increase myocardial contractility and cardiac output in the state of hypotension.

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Dopamine (Intropin)

 

Stimulates alpha1 adrenergic, beta-adrenergic, and dopaminergic receptors, which are stimulated at lower doses (< 2 mcg/kg/min) and result in renal and mesenteric arterial vasodilation. Beta-adrenergic stimulation occurs at doses of 2-10 mcg/kg/min with positive inotropic effects. Alpha-adrenergic stimulation at doses >10 mcg/kg/min results in vasoconstriction and increase in blood pressure and afterload.

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Dobutamine (Dobutrex)

 

Primarily a beta-receptor agonist with both inotropic and chronotropic effects.

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Vasodilators

Class Summary

May be used in VSD and MR to decrease afterload and, subsequently, severity of shunt.

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Sodium nitroprusside (Nitropress)

 

Reduces peripheral resistance by acting directly on arteriolar and venous smooth muscle.

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Nitroglycerin IV (Nitro-Bid, Nitrostat)

 

Primarily a venodilator that decreases both preload and afterload. Preferred over sodium nitroprusside in AMI.

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Diuretics

Class Summary

Can be used in pulmonary edema caused by VSD or MR.

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Furosemide (Lasix)

 

A loop diuretic that decreases preload by reducing plasma volume and direct vasodilation.

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Contributor Information and Disclosures
Author

Jamshid Shirani, MD  Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, St Luke's Hospital and Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Echocardiography, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Coauthor(s)

Jamshid Alaeddini, MD, FACC  Clinical Cardiac Electrophysiologist, Inland Cardiology Associates

Jamshid Alaeddini, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; St. Jude Honoraria Speaking and teaching; Reliant Honoraria Speaking and teaching

Alessandra Brofferio, MD  Fellow, Department of Cardiovascular Medicine, Geisinger Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric Vanderbush, MD, FACC  Chief, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center; Clinical Assistant Professor of Cardiology, Columbia University College of Physicians and Surgeons

Eric Vanderbush, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marschall S Runge, MD, PhD  Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD  Associate Professor of Medicine, Director of Interventional Cardiology Fellowship Program, Henry Ford Hospital

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

References

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Photograph of the heart of a 43-year-old man demonstrating the site of a stab wound over the left ventricular lateral free wall (shown as a vertical tear).
Photograph of a heart sectioned transversely at the mid left ventricular level showing a posterior ventricular septal defect at the site of a recent acute myocardial infarction.
Photograph of the mitral valve and subvalvular apparatus showing the site of an ischemic papillary muscle (PM) rupture (R).
Magnified photograph of a transverse section of the mid left ventricle (LV) showing a transmural lateral free-wall rupture (R).
Chest radiograph in posteroanterior projection showing a large pseudoaneurysm manifesting as a bulge in the left cardiac border.
 
 
 
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