Heart Transplant patients

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Specializes in ICU/Critical Care.

So I have a patient who is 8 years post heart transplant. From my understanding these patients are not suppose to receive Atropine for bradycardia. So whats the standard medication for bradycardia in heart transplant patients?

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Specializes in Acute post op ortho.

I did the whole 'google scholar' thing & came up empty. I guess you give what the doctor prescribes.

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Specializes in ICU/Critical Care.

Thanks but I don't wanna just give what the doc prescribes because what if it's the wrong drug? I want to know if there is another med in place of atropine that I could give for bradycardia in these patients. I know I can also transcutaneously pace them.

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Specializes in NICU, PICU, PCVICU and peds oncology.

The reason that patients s/p heart transplant don't get atropine for symptomatic bradycardia is that their hearts are denervated and won't respond to it. Atropine has many side effects and so is not a benign drug to use with impugnity. Over time some autonomic re-innervation usually occurs, although the mechanism is unknown. This makes the heart more responsive to anticholinergics like atropine. Most centers will go directly to transcutaneous pacing in symptomatic bradycardic heart recipients who no longer have pacing wires in situ. The University of Florida Health Sciences Center found that IV theophylline is an effective treatment for symptomatic bradycardia (when coupled with temporary pacing) in heart recipients back in 1996. The cause of post-operative bradycardia in heart recipients is thought to be endogenous adenosine and theophylline is an adenosine receptor antagonist, so it makes sense that it would help with the bradycardia. But this has not been incorporated into ACLS protocols for hemodynamically significant bradycardia in the heart recipient. So pacing is still the treatment of choice.

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Specializes in CRNA.

Isoproterenol works well being that it is a mostly pure beta 1 agonist. Doesnt hurt to try an anticholinergic though, just don't expect the usual results.

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Specializes in ER.

I also believe that the vagal nerve is cut and atropine isn't effective because of this. Am I right or am I crazy??

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Specializes in NICU, PICU, PCVICU and peds oncology.
I also believe that the vagal nerve is cut and atropine isn't effective because of this. Am I right or am I crazy??

That's what "denervated" means in this case.

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Specializes in Oncology.
I guess you give what the doctor prescribes.

I've never once used this as the logic for giving a medication. I'm a professional, who has my own responsibility to my patient.

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Specializes in ICU/Critical Care.

Thanks for the info. Took care of the patient last night, her heart rate kept dropping into the 50s along with her BP. Her heart rate and BP would stay that way for a minute then go back up to SR and her BP would stabilize. I'm not working tonight so I don't know what happened today.

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Specializes in Oncology.
Thanks for the info. Took care of the patient last night, her heart rate kept dropping into the 50s along with her BP. Her heart rate and BP would stay that way for a minute then go back up to SR and her BP would stabilize. I'm not working tonight so I don't know what happened today.

If her bp and HR were both dropping, dopamine may help. I'm not sure if that would work in an heart tx patient, but may be worth considering.

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