[MacNurse]

Anyone else out there have problems with milranon and significant decreases in (well...down right scary decreases actually) blood pressure?

[heartICU]

Originally Posted by MacNurse

Anyone else out there have problems with milranon and significant decreases in (well...down right scary decreases actually) blood pressure?

yeah, it's one of the common side effects of milrinone. In fact, if you look at the anticipated result of milrinone, you almost want some degree of hypotension. Milrinone is an afterload reducer (Balloon pump in a bottle), so if your afterload is decreased, your heart has a less difficult time maintaining an adequate cardiac output. When my patients are on milrinone, many of them also have a levo drip.

[Tenesma]

but if your afterload is appropriately reduced and the milrinone is improving your C.O., don't be surprised if your BP actually starts getting better after the vasodilatory dip...

plus in some patients it might be better not to use a loading dose of milrinone, or maybe only half the usual weight based loarding dose...

[MacNurse]

Thanks! I had a physican tell me that my patient's BP of 60/32 (yes he was still conscious...norm of 110/65) was totally unrelated to the drug! A very frustrating situation over all..the guy was having chest pain (10/10)...couldn't give him nitro...he can't be cath'd...dr refused to give him anything to anything to raise his BP or for pain...got stuck between a rock and a dumb physican.....

[Tenesma]

why couldn't you give nitro? it might have been appropriate for that guy...

[MacNurse]

Cause his BP was in the crapper.....vasodilating someone with a BP systolic of like 60 falls into the bad idea catagory with me.....

[Tenesma]

if his BP is in the crapper because he is having coronary vasoconstriction in the setting of an acute coronary syndrome (ie: MI) then providing coronary vasodilation may actually improve blood flow to the affect ventricular wall, thus allowing for improved performance and improvement of the BP. This coronary vasodilation can sometimes/often be obtained with nitroglycerin...

I use nitroglycerin often on my cardiac patients even when their BP is in the toilet with good results... it freaks out the Medicine people cause they really don't understand cardiac physiology that well

you can always offset the systemic vasodilation you get with low to moderate dose nitroglycerin with some norepinephrine...

it sounds though that your situation was a bit different. You started milrinone that dropped this guys pressure because of his systemic and pulmonary vasodilation from the milrinone.... if he was having chest pain because of the drop in coronary perfusion then what he needs is systemic vasoconstriction to improve his coronary diastolic pressures...

[candyndel]

I am confused now because Primacor is a vasodilator (albeit antiquated in the world of cardiology).
That's why they used to use it for pts with ADHF.... what were you using it for?

Originally Posted by MacNurse

Cause his BP was in the crapper.....vasodilating someone with a BP systolic of like 60 falls into the bad idea catagory with me.....

[candyndel]

Gotta watch those RV infarcts though! Its all about the preload!!

Originally Posted by Tenesma

if his BP is in the crapper because he is having coronary vasoconstriction in the setting of an acute coronary syndrome (ie: MI) then providing coronary vasodilation may actually improve blood flow to the affect ventricular wall, thus allowing for improved performance and improvement of the BP. This coronary vasodilation can sometimes/often be obtained with nitroglycerin...

I use nitroglycerin often on my cardiac patients even when their BP is in the toilet with good results... it freaks out the Medicine people cause they really don't understand cardiac physiology that well

you can always offset the systemic vasodilation you get with low to moderate dose nitroglycerin with some norepinephrine...

it sounds though that your situation was a bit different. You started milrinone that dropped this guys pressure because of his systemic and pulmonary vasodilation from the milrinone.... if he was having chest pain because of the drop in coronary perfusion then what he needs is systemic vasoconstriction to improve his coronary diastolic pressures...

[ghmccart]

my concern is that you did not look up the medication and anticipate that before you gave it, it is a serious cardiac medication and should be given by knowledgable hands. asking us hear on this forum is ok, but man you need to empower your self.