Question about dopamine

[lenka SRN]

Besides dopamine having an inotropic effect on the myocardium. Are there any other specific concerns regarding a patient with chest pain on a dopamine drip?

[lenka SRN]

What is the treatment for peripherally infiltrated dopamine?

[kmoonshine, RN]

Regitine (phentolamine).

Unless the person is coding, always use a central line for dopamine.

[HouTx, BSN, MSN, EdD]

Effects of dopamine vary according to the mcg/kg. What mcg/kg are you referring to?

At higher dosages, it will increase afterload, thereby increasing O2 consumption/myocardial workload & increasing chestpain related to inadequate cellular oxygenation.

[lenka SRN]

This was a generic question for school from a case study, mcg/min were not given. My assumption is that they wanted us to come up with any concerns related to a patient with chest pain on a dopamine drip and give rationale for our answer. Your answer was very helpful thank you very much!

[MN BigJ]

I'm sure for school they are looking for something to the effect that dopamine causes the increased contractility and increased CO which could cause chest pain I suppose. They usually don't want you to get in in depth on how exactly the drug is working, just what it is doing.

But in reality, if your pt is in need of pressers and they have to be turned up high enough to cause chest pain, then the chest pain is the least of their worries. :wink2:

[MN BigJ]

I guess I assumed that the pt was on dopamine first, then had chest pain. I guess if the question is that the person has chest pain and then requires dopamine then your concern would be the increased work load on the myocardium if the pt is having an MI. Either way an 12 lead EKG would be in order.

[Putu2Sleep]

In a patient having chest pain, what specific concerns may you have regarding a dopamine drip?

Thank you in advance!

Dopamine is an inotrope that can increase the pt's HR and in turn increase myocardial oxygen demand making the chest pain even worse.

[rickard]

Another consideration (side effect ) of increasing the contractility of the myocardium is it also increases the irritability. Dopamine causes this less then some of the more powerful inotropes but at higher doses does cause similar effect . The consequence of the increased irritability, more frequent PAC's possibly leading to afib? or frequent PVC's leading to Vtach? Treatment for these are antiarrhythmic agents which most have negative inotropic effect. So a catch 22 has just happened. :)

[mtwedt]

I agree with the other posters. The primary concern in using Dopamine, or other positive inotropes, in the setting of chest pain, is that of increasing myocardial O2 demand in an ischemic heart, thereby increasing ischemia and potential for arrythmias. In the most acute cases of ischemia and chest pain accompanied by significant hypotension unresponsive to fluids, ie.. cardiogenic shock or evolving cardiogenic shock, the treatment is IABP and a very quick trip to the cath lab for intervention and/or possible emergent cardiac surgery.