Muscular Ventricular Septal Defect Medication

Updated: Jan 04, 2016
  • Author: Michael D Taylor, MD, PhD; Chief Editor: Stuart Berger, MD  more...
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Medication

Medication Summary

Diuretics are the mainstay of medical therapy in infants and children with large ventricular septal defects (VSDs), large left-to-right shunts, and evidence of congestive heart failure (CHF). Many centers also use digoxin, but some debate surrounds its efficacy, especially in infants. The patient’s hemoglobin level should be adequate.

Afterload reduction may be beneficial in certain situations. As previously mentioned, ACE inhibitors have a potassium-sparing effect. When these are used, spironolactone or supplemental potassium should be avoided or judiciously used.

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Diuretics

Class Summary

These agents relieve ventricular volume load and peripheral and pulmonary congestion. They promote excretion of water and electrolytes by the kidneys and are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites.

Furosemide (Lasix)

Furosemide increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule.

Spironolactone (Aldactone)

Spironolactone is used for the management of edema resulting from excessive aldosterone excretion. It competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.

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Angiotensin Converting Enzyme (ACE) Inhibitors

Class Summary

These afterload reduction agents decrease systemic afterload and, therefore, may decrease left-to-right shunting through a large ventricular septal defect (VSD). They are used to improve preoperative or postoperative cardiac output, reducing systemic vascular resistance and increasing blood flow resulting from myocardial dysfunction and/or significant mitral valve insufficiency.

Enalapril (Vasotec)

Enalapril is a competitive ACE inhibitor; it reduces angiotensin II levels, decreasing aldosterone secretion.

Captopril

Captopril prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

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Cardiac Glycosides

Class Summary

These inotropic agents are used to augment ventricular contractility. Positive inotropic agents increase the force of contraction of the myocardium and are used to treat acute and chronic CHF. Some may also increase or decrease the heart rate (ie, positive or negative chronotropic agents), provide vasodilatation, or improve myocardial relaxation. These additional properties influence the choice of drug for specific circumstances. Digoxin is predominantly used for its inotropic effect.

Digoxin (Lanoxin)

Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. It acts directly on cardiac muscle, increasing myocardial systolic contractions. Digoxin's indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

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