Myocardial Rupture Medication

Updated: Nov 10, 2014
  • Author: Jamshid Shirani, MD; Chief Editor: Eric H Yang, MD  more...
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Medication

Medication Summary

Medications are useful to help stabilize patients who are waiting for emergency surgery. Agents used in patients who have sustained a myocardial rupture include inotropes, vasodilators, and diuretics.

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Inotropic Agents

Class Summary

Inotropes are used in patients with a ventricular septal defect (VSD) or free-wall rupture to increase myocardial contractility and cardiac output in the state of hypotension.

Dopamine

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

Dobutamine

Dobutamine is primarily a beta-receptor agonist with both inotropic and chronotropic effects.

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Vasodilators

Class Summary

Vasodilators may be used in patients with VSD or mitral regurgitation (MR) to decrease afterload and, subsequently, shunt severity.

Sodium nitroprusside (Nitropress)

Sodium nitroprusside reduces peripheral resistance by acting directly on arteriolar and venous smooth muscle.

Nitroglycerin IV (Nitro-Bid, Nitrostat, Nitro-Dur, Nitrolingual, NitroMist)

Nitroglycerin is primarily a venodilator that decreases both preload and afterload. It is preferred to sodium nitroprusside in patients with acute myocardial infarction (AMI).

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Diuretics, Loop

Class Summary

Diuretics can be used in pulmonary edema caused by VSD or MR.

Furosemide (Lasix)

Furosemide is a loop diuretic that decreases preload through reduction of plasma volume and direct vasodilation.

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