Cardiogenic shock induced by a high dose of intravenous morphine

Anand, Łukasz Piotr Sein; Korolkiewicz, Paweł Konstanty; Anand, Jacek Sein

doi:10.13075/ijomeh.1896.01629

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…The literature is very consistent in not using only pharmacological treatments in individuals with chronic pain, the recommendation is that a multidisciplinary treatment be performed [12,13,16,18,21,24,[31][32][33][34]41,42].…”

Section: Discussionmentioning

confidence: 99%

Pain As A Potential Impact Factor In Cardiac Rehabilitation: Literature Review

Rocha da Silva,

de Oliveira

2023

Med Clin Sci

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ntroduction: Cardiovascular diseases are responsible for substantial damage to the health system, being the main cause of mortality in the world, just as pain is the main cause of disability in the world. It is common for individuals diagnosed with both pathologies as well as other comorbidities, to be associated with a high risk of mortality. The study of pain in this specific population can bring us greater clarity on the impact it has on cardiac rehabilitation. Objective: To identify studies that researched the impact of pain in patients with cardiovascular disease, and to analyze the impact of pain on the rehabilitation of these individuals. Methods: We performed an integrative literature review in the PUBMED database based on clinical practice, selecting studies that evaluated pain, functional capacity, quality of life, and treatment adherence, the studies were analyzed according to criteria of practice based on scientific evidence. Results: A total of 380 studies using the search strategy, where 55 studies were selected after reading the title and abstract, and after analysis 23 studies were included according to the inclusion criteria. Despite the high relevance of the subject in the literature, there are still few studies with a high level of scientific evidence, which address the impact of pain in individuals with cardiovascular disease, but primary studies have shown a direct correlation between the two pathologies, being associated with clinical worsening of these individuals, highlighting the importance of a better approach to pain. Conclusion: Pain is a common pathology among individuals with cardiovascular disease, decreasing functional capacity, and treatment adherence, and triggering changes in the autonomic nervous system, which can negatively impact cardiac rehabilitation

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Section: Discussionmentioning

confidence: 99%

Pain As A Potential Impact Factor In Cardiac Rehabilitation: Literature Review

Rocha da Silva,

de Oliveira

2023

Med Clin Sci

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“…The evidence collected likely would not suffice to support the safety of morphine in the treatment of patients with AHF. The latest studies found that both the deterioration of renal function and the incidence of cardiogenic shock in patients with AHF are related to the use of morphine 28,29 . Undeniably, more RCTs should be conducted to observe whether patients with AHF should receive morphine.…”

Section: Discussionmentioning

confidence: 99%

“…The latest studies found that both the deterioration of renal function and the incidence of cardiogenic shock in patients with AHF are related to the use of morphine. 28 , 29 Undeniably, more RCTs should be conducted to observe whether patients with AHF should receive morphine. It is only with RCTs with adequate sample sizes that we will be able to provide a reliable answer to the question as to whether the use of morphine is necessary.…”

Section: Discussionmentioning

confidence: 99%

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Zhang

Wei

Liu

et al. 2021

Clinical Cardiology

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While morphine has long been widely used in treating acute heart failure (AHF) due to its vasodilatory properties and anticipated anxiolysis, it remains unclear whether the application of morphine to those patients is reasonable. We aim to conduct a systematic review and meta‐analysis to assess the safety of morphine in patients with AHF. We searched PubMed, Cochrane Library, and Embase electronic databases from inception through March 2020. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the outcomes. Seven studies with 172, 226 patients were included. The results showed that morphine usage was not associated with increased in‐hospital mortality (OR: 1.94; 95% CI 0.93 to 4.03; p = 0.08). However, the use of morphine significantly increased the risk of invasive ventilation (OR: 2.72; 95% CI 1.09 to 6.80; p = 0.03). Furthermore, the subgroup analysis indicated that the application of morphine was not associated with increased 7‐day all‐cause mortality in patients with AHF (OR: 1.69; 95% CI 0.80 to 3.22; p = 0.11) but significantly increased the risk of 30‐day all‐cause mortality (OR: 1.59; 95% CI 1.16 to 2.17; p = 0.004). Based on current evidence, our results suggested that although morphine therapy did not significantly increase the risk of short‐term death (in the hospital or within 7 days) in patients with AHF, the risk of long‐term death and invasive ventilation were significantly increased. This result needs to be further confirmed by an ongoing randomized control trial.

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“…1 right), indicating that the rapidly appearing vasodilator action may play a more critical role than the slowly developing cardiosuppressive effects. Thus, the high dose of morphine is considered to induce distributive shock rather than cardiogenic shock, although there were some reports describing that morphine induced cardiogenic shock with reducing left ventricular ejection fraction (Feeney et al, 2011;Sein Anand et al, 2021). In addition, we used the ENAP ventilation to rescue the 2 animals showing hemodynamic collapse during the high dose infusion.…”

Section: Cardiohemodynamic Effectsmentioning

confidence: 99%

Analysis of cardiohemodynamic and electrophysiological effects of morphine along with its toxicokinetic profile using the halothane-anesthetized dogs

Goto,

Kambayashi,

Fujishiro

et al. 2024

J. Toxicol. Sci.

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Although morphine has been used for treatment-resistant dyspnea in end-stage heart failure patients, information on its cardiovascular safety profile remains limited. Morphine was intravenously administered to halothane-anesthetized dogs (n=4) in doses of 0.1, 1 and 10 mg/kg/10 min with 20 min of observation period. The low and middle doses attained therapeutic (0.13 µg/mL) and supratherapeutic (0.97 µg/mL) plasma concentrations, respectively. The low dose hardly altered any of the cardiovascular variables except that the QT interval was prolonged for 10-15 min after its start of infusion. The middle dose reduced the preload and afterload to the left ventricle for 5-15 min, then decreased the left ventricular contractility and mean blood pressure for 10-30 min, and finally suppressed the heart rate for 15-30 min. Moreover, the middle dose gradually but progressively prolonged the atrioventricular conduction time, QT interval/QTcV, ventricular late repolarization period and ventricular effective refractory period without altering the intraventricular conduction time, ventricular early repolarization period or terminal repolarization period. A reverse-frequency-dependent delay of ventricular repolarization was confirmed. The high dose induced cardiohemodynamic collapse mainly due to vasodilation in the initial 2 animals by 1.9 and 3.3 min after its start of infusion, respectively, which needed circulatory support to treat. The high dose was not tested further in the remaining 2 animals. Thus, intravenously administered morphine exerts a rapidly appearing vasodilator action followed by slowly developing cardiosuppressive effects. Morphine can delay the ventricular repolarization possibly through I Kr inhibition in vivo, but its potential to develop torsade de pointes will be small.

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Cardiogenic shock induced by a high dose of intravenous morphine

Cited by 5 publications

References 23 publications

Pain As A Potential Impact Factor In Cardiac Rehabilitation: Literature Review

Pain As A Potential Impact Factor In Cardiac Rehabilitation: Literature Review

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Analysis of cardiohemodynamic and electrophysiological effects of morphine along with its toxicokinetic profile using the halothane-anesthetized dogs

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