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. 1980 Apr 5;280(6219):980–982. doi: 10.1136/bmj.280.6219.980

Haemodynamic effects of intravenous morphine in patients with acute myocardial infarction complicated by severe left ventricular failure.

A D Timmis, M T Rothman, M A Henderson, P W Geal, D A Chamberlain
PMCID: PMC1601124  PMID: 7417767

Abstract

The haemodynamic effects of intravenous morphine sulphate (0.2 mg/kg body weight) were measured in 10 patients with acute myocardial infarction complicated by severe left ventricular failure. Fifteen minutes after morphine injection there was a significant fall in mean heart rate (from 109 to 101 beats/min) and mean systemic arterial pressure (from 80 to 65 mm HG), and a small fall in mean cardiac index (from 2.4 to 2.21/min/m2). Haemodynamic changes at 45 minutes were similar. Neither stroke index nor indirect left ventricular filling pressure (measured as pulmonary artery end-diastolic pressure) were consistently improved 15 or 45 minutes after injection. The useful action of morphine in relieving distressing cardiac dyspnoea is not adequately explained by systemic venous blood pooling. These results suggest that the effects of morphine on the central nervous system are more important.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. EBERT R. V. The lung in congestive heart failure. Arch Intern Med. 1961 Mar;107:450–459. doi: 10.1001/archinte.1961.03620030138018. [DOI] [PubMed] [Google Scholar]
  2. Flaim S. F., Zelis R., Eisele J. H. Differential effects of morphine on forearm blood flow: attenuation of sympathetic control of the cutaneous circulation. Clin Pharmacol Ther. 1978 May;23(5):542–546. doi: 10.1002/cpt1978235542. [DOI] [PubMed] [Google Scholar]
  3. Henney R. P., Vasko J. S., Brawley R. K., Oldham H. N., Morrow A. G. The effects of morphine on the resistance and capacitance vessels of the peripheral circulation. Am Heart J. 1966 Aug;72(2):242–250. doi: 10.1016/0002-8703(66)90448-0. [DOI] [PubMed] [Google Scholar]
  4. Lal S., Savidge R. S., Chhabra G. P. Cardiovascular and respiratory effects of morphine and pentazocine in patients with myocardial infarction. Lancet. 1969 Feb 22;1(7591):379–381. doi: 10.1016/s0140-6736(69)91351-8. [DOI] [PubMed] [Google Scholar]
  5. Lappas D. G., Geha D., Fischer J. E., Laver M. B., Lowenstein E. Filling pressures of the heart and pulmonary circulation of the patient with coronary-artery disease after large intravenous doses of morphine. Anesthesiology. 1975 Feb;42(2):153–159. doi: 10.1097/00000542-197502000-00007. [DOI] [PubMed] [Google Scholar]
  6. Leaman D. M., Levenson L., Zelis R., Shiroff R. Effect of morphine on splanchnic blood flow. Br Heart J. 1978 May;40(5):569–571. doi: 10.1136/hrt.40.5.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Lee G., DeMaria A. N., Amsterdam E. A., Realyvasquez F., Angel J., Morrison S., Mason D. T. Comparative effects of morphine, meperidine and pentazocine on cardiocirculatory dynamics in patients with acute myocardial infarction. Am J Med. 1976 Jun;60(7):949–955. doi: 10.1016/0002-9343(76)90565-9. [DOI] [PubMed] [Google Scholar]
  8. Moffitt E. A., Tarhan S., Rodriguez R., Barnhorst D. A., Pluth J. R. Hemodynamic effects of morphine during and early after cardiac operations. Anesth Analg. 1976 Jan-Feb;55(1):47–50. doi: 10.1213/00000539-197601000-00012. [DOI] [PubMed] [Google Scholar]
  9. Popio K. A., Jackson D. H., Ross A. M., Schreiner B. F., Yu P. N. Hemodynamic and respiratory effects of morphine and butorphanol. Clin Pharmacol Ther. 1978 Mar;23(3):281–287. doi: 10.1002/cpt1978233281. [DOI] [PubMed] [Google Scholar]
  10. Robin E. D., Cross C. E., Zelis R. Pulmonary edema. 2. N Engl J Med. 1973 Feb 8;288(6):292–304. doi: 10.1056/NEJM197302082880606. [DOI] [PubMed] [Google Scholar]
  11. Scott M. E., Orr R. Effects of diamorphine, methadone, morphine, and pentazocine in patients with suspected acute myocardial infarction. Lancet. 1969 May 31;1(7605):1065–1067. doi: 10.1016/s0140-6736(69)91704-8. [DOI] [PubMed] [Google Scholar]
  12. Thomas M., Malmcrona R., Fillmore S., Shillingford J. Haemodynamic effects of morphine in patients with acute myocardial infarction. Br Heart J. 1965 Nov;27(6):863–875. doi: 10.1136/hrt.27.6.863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Vasko J. S., Henney R. P., Oldham H. N., Brawley R. K., Morrow A. G. Mechanisms of action of morphine in the treatment of experimental pulmonary edema. Am J Cardiol. 1966 Dec;18(6):876–883. doi: 10.1016/0002-9149(66)90433-4. [DOI] [PubMed] [Google Scholar]
  14. Vismara L. A., Leaman D. M., Zelis R. The effects of morphine on venous tone in patients with acute pulmonary edema. Circulation. 1976 Aug;54(2):335–337. doi: 10.1161/01.cir.54.2.335. [DOI] [PubMed] [Google Scholar]
  15. Ward J. M., McGrath R. L., Weil J. V. Effects of morphine on the peripheral vascular response to sympathetic stimulation. Am J Cardiol. 1972 May;29(5):659–666. doi: 10.1016/0002-9149(72)90167-1. [DOI] [PubMed] [Google Scholar]
  16. Zelis R., Mansour E. J., Capone R. J., Mason D. T. The cardiovascular effects of morphine. The peripheral capacitance and resistance vessels in human subjects. J Clin Invest. 1974 Dec;54(6):1247–1258. doi: 10.1172/JCI107869. [DOI] [PMC free article] [PubMed] [Google Scholar]

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