Thoracic Aneurysm Medication

  • Author: Bret P Nelson, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Sep 1, 2011
 

Medication Summary

The goal of medical therapy is to reduce the pulse pressure (dP/dt) within the aorta. Reducing the heart rate, the blood pressure (BP), pain, and anxiety are the mainstays of therapy.

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Antihypertensive agents

Class Summary

These agents are used to reduce arterial pressure. Short-acting IV beta blockade and nitrates are very effective in reducing the dP/dt, especially in the ascending aorta. Consider calcium channel blockade in patients with contraindications to beta blockade.

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Esmolol (Brevibloc)

 

Ultra–short-acting beta1-blocker particularly useful in patients with labile arterial pressure because it can be abruptly discontinued if necessary. Typically used in conjunction with nitroprusside. May be useful as a means to test beta-blocker safety and tolerance in patients with history of obstructive pulmonary disease who are at uncertain risk of bronchospasm from beta blockade. Elimination half-life is 9 min. The objective is a target heart rate of 55-65 bpm.

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Labetalol (Normodyne, Trandate)

 

Blocks alpha-, beta1-, and beta2-adrenergic receptor sites, decreasing BP.

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Metoprolol (Lopressor)

 

Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions. During IV administration, carefully monitor BP, heart rate, and ECG. When considering conversion from IV to PO dosage forms, use ratio of 2.5 mg PO to 1 mg IV metoprolol.

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Propranolol (Inderal, Betachron E-R)

 

Class II antiarrhythmic nonselective beta-adrenergic receptor blocker. Has membrane-stabilizing activity and decreases automaticity of contractions. Not a first-line agent in the treatment of hypertensive emergencies. Do not administer IV in hypertensive emergencies.

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Nitroprusside (Nipride, Nitropress)

 

Causes peripheral vasodilation by direct action on venous and arteriolar smooth muscle, thus reducing peripheral resistance. Commonly used IV because of rapid onset and short duration of action. Easily titratable to reach desired effect. Light sensitive; both bottle and tubing should be wrapped in aluminum foil. Prior to initiating, administer beta-blocker to counteract physiologic response of reflex tachycardia that occurs when nitroprusside is used alone. This physiologic response increases shear forces against aortic wall, thus increasing dP/dT.

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Analgesics

Class Summary

Analgesics are used to control pain and to decrease sympathetic tone.

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Morphine sulfate (Astramorph, Infumorph)

 

DOC for narcotic analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Like fentanyl, morphine sulfate is easily titrated to desired level of pain control. If administered IV, may be dosed in a number of ways; commonly titrated until desired effect obtained.

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Contributor Information and Disclosures
Author

Bret P Nelson, MD  Associate Professor of Emergency Medicine, Director of Emergency Ultrasound, Department of Emergency Medicine, Mount Sinai School of Medicine

Bret P Nelson, MD is a member of the following medical societies: American College of Emergency Physicians, American Institute of Ultrasound in Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Eric M Isselbacher, MD  Associate Professor of Medicine, Harvard Medical School; Associate Director, Massachusetts General Hospital Heart Center; Co-Director, Thoracic Aortic Center, Massachusetts General Hospital

Eric M Isselbacher, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

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

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  15. Safi HJ, Miller CC. Thoracic vasculature. In: Townsend CM, Beauchamp DR, Evers MB, et al, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, Pa: WB Saunders Co; 2001.

 
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Descending thoracic aortic aneurysm with mural thrombus at the level of the left atrium.
 
 
 
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