clear1x1.gif
clear1x1.gif
clear1x1.gif
CardiologySite logo
Coronary Angio
Auscultation
Cardiology Quiz
Site Info
 
Home
 
Site Map

 

clear1x1.gif clear1x1.gif
Prior Page Answer to AQ 008 Next Page
  Your answer (E) is not the one that we were looking for. (C) is correct!
  • A beta-blocker is contraindicated in this patient with a history of bronchial asthma and active rhonchi. Otherwise, IV nitroprusside and a beta-blocker would have been the combination of choice.
    • Beta-blockers reduce the pulsatile aortic flow (dp/dt).
    • If not contraindicated, the following beta-blockers can be used:
    • Propranolol IV (0.15 mg/kg given over a 5 minute period and repeated, as needed, to maintain the pulse at 60/min.
    • The short acting esmolol may be used IV as a (approximately 0.5-1 mg/kg) bolus dose over 30-60 seconds followed by a 150 mcg/kg/min infusion, if necessary. Adjust the infusion rate as required up to 300 mcg/kg/min to maintain the desired heart rate and/or blood pressure. If tolerated, other beta-blockers may be substituted.
    • IV metoprolol 1 mg q 1-3 min for maximum of 5 mg loading dose may be given in patients with questionable bronchospastic disease. The dose may be repeated, as needed.
  • IV labetolol may be successfully used as a single agent in the treatment of acute aortic dissection. 20 mg labetalol (which corresponds to 0.25 mg/kg for an 80 kg patient) by slow intravenous injection over a 2-minute period. Additional injections of 20 mg or 80 mg can be given at 10-minute intervals until a desired supine blood pressure and pulse rate is achieved or a total of 300 mg labetalol HCl has been injected. The maximum effect usually occurs within 5 minutes of each injection.
    Other agents employed in the treatment of acute aortic dissection are:
  • IV nitroprusside (50 mg in 1000 ml 5% D/W) may be started at 0.5 ml/min and increased by 0.5ml/min q 5 min until BP is adequately controlled. Check thiocyanate levels if treatment is continued for 48 hours. Stop infusion if the level reaches 10 mg/dl
  • IV trimethaphan (1-2 mg/ml) reduces LV contractility and may be infused (with the patient in a semi-Fowler position) as a single agent when nitroprusside and beta-blockers are contraindicated or not tolerated. The drug is associated with sympathoplegia (blurred vision, urinary retension and orthostatic hypotension) and rapid tolerance.
  • IV fenoldopam (0.1-1.6 ug/kg/min) may also be used for controlling hypertension
  • IV reserpine (0.1-0.2 mg) may be used if beta-blockers are contra-indicated
You may review the previous question again, if you so desire, by clicking on the left corner prior key.
Prior Page Exit Next Page
©1999-2007, A.S.M. Systems, Inc. All Rights Reserved, including design and all contents that include graphics and animations.
clear1x1.gif
clear1x1.gif
clear1x1.gif