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Old 10-15-2011
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Heart Morphine and preload reduction

How exactly does Morphine reduces preload in cases as acute pulmonary edema?
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Old 10-15-2011
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The first thing is the vasodilator effects of morphine. Allows more blood flow, lowering pressures -> Allows the heart to work more effectively -> less fluid gets stuck in the pulmonary structures. Then relieve shortness of breath and anxiety.
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Old 10-15-2011
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Use of morphine sulfate in CPE for preload reduction has been commonplace for many years. Good evidence supporting a beneficial hemodynamic effect is lacking. Data suggest that morphine sulfate may contribute to a decrease in cardiac output and that it may be associated with an increased need for ICU admission and endotracheal intubation.

Adverse effects (eg, nausea and vomiting, local or systemic allergic reactions, respiratory depression) may outweigh any potential benefit, especially given the availability of medications that are more effective than morphine in reducing preload (eg, NTG).

Any beneficial hemodynamic effect is probably due to anxiolysis, with a resulting decrease in catecholamine production and decrease in systemic vascular resistance. An alternative can be low-dose benzodiazepines (eg, lorazepam 0.5 mg IV) in patients who are extremely anxious. This alternative reduces the risk of respiratory depression in patients whose condition responded to initial therapy.

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