adenosine vasodilation
Vasodilation of the coronary arteries occurs through activation of the A2A receptors in vascular smooth muscle cells and is endothelium-independent. Prevention and treatment of radial artery spasm during transradial cardiac catheterization
In the presence of normal, “healthy” endothelium, acetylcholine produces coronary vasodilation; but in the setting of dysfunctional endothelium it results in vasoconstriction. In the Acute Myocardial Infarction STudy of Adenosine (AMISTAD) II trial, IV adenosine (3-h infusion, 50 to 70 µg/kg/min) administered prior to revascularization for acute MI was associated with reduced infarct size, but no improvement in clinical outcomes. Indications for the use of calcium channel blockers during cardiac catheterization/intervention: Induction of maximal hyperemia for invasive physiologic assessment of intermediate coronary lesions For the treatment of no-reflow, 50 to 100 µg IC bolus can be used and repeated as needed.
Calcium channel blockers also bind to calcium channels on cardiac myocytes resulting in reduced cardiac contractility. Intraarterial verapamil 3 mg may be given for the prevention of radial artery spasm during transradial catheterization. Various doses of IC nitroprusside have been used in the management of no-reflow and repeated doses may be required to achieve satisfactory coronary flow. A typically used dose of IC verapamil is 200 µg IC bolus, and can be repeated 2 to 4 times as needed. The no-reflow phenomenon is characterized by a reduction in epicardial blood flow despite patency of the vessel, and is due to compromise of the integrity of the microvascular circulation.
The infusion should be limited to 48 hours in duration because cyanide toxicity can occur over time as cumulative doses increase.
Hypotension (systolic blood pressure [SBP] <90 mm)
When compared to IC verapamil (200 µg) and diltiazem (1 mg), IC nicardipine (200 µg) appears to offer more potent and prolonged microvascular dilation with less risk of heart block.
Levine, GN, Bates, ER, Blankenship, JC. Actions of adenosine include relaxing vascular smooth muscle (vasodilation), increasing blood flow (circulation), modulating neurotransmitter release, protecting the brain from oxidative stress, regulating T cell proliferation and cytokine production, and …
It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles.The process is the opposite of vasoconstriction, which is the narrowing of blood vessels.
IC verapamil is also associated with improved angiographic outcomes for the treatment and prevention of no-reflow in SVG interventions. It is also used as a research tool to evaluate the endothelium. A randomized, double-blind, placebo-controlled clinical trial”. However, it does not have an approved indication as a vasodilator in the catheterization laboratory currently.
Typical starting doses are 50 to 100 µg IC, although doses up to 5 mg have been administered. )(Small RCT [n= 54] showing that intracoronary adenosine administration is feasible and well tolerated in AMI, and that it ameliorates flow, prevents no-reflow and improves ventricular function after primary PTCA. Spasm of the ostium of the right coronary artery or the left main artery may be more effectively treated with sublingual or IV nitrates, since ostial segments may be less exposed to nitroglycerin administered through the diagnostic or guiding catheter. IC calcium channel blockers may also be effective for the treatment of epicardial coronary artery spasm, including nitroglycerin-resistant spasm. Close more info about Interventional Pharmacology—Vasodilators Prevention/treatment of radial artery spasm during transradial cardiac catheterization “Prospective, randomized, controlled trial to study the effect of intracoronary injection of verapamil and adenosine on coronary blood flow during percutaneous coronary intervention in patients with acute coronary syndromes”. For the treatment of reentrant supraventricular arrhythmias, 6 to 12 mg IV boluses are usually administered and repeated if necessary. The principle physiologic action of nitroglycerin is vasodilation, particularly of the systemic veins but also of the coronary and peripheral arteries. Read an unlimited amount by logging in or registering at no cost.Please login or register first to view this content. Methylxanthines (e.g., caffeine, theophylline) are competitive antagonists of adenosine receptors, and thus high doses of adenosine may be necessary in patients using these substances. Sublingual or intravenous (IV) nitroglycerin can be used for periprocedural control of hypertension, and for the treatment of patients with angina or decompensated heart failure in the cardiac catheterization laboratory.
Nitrate-induced hypotension typically results from combined venous and arterial dilation. “2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions”.
It can also be helpful in appropriate sizing of balloons and stents. In cases of refractory no-reflow, the combination of IC adenosine and nitroprusside is safe and may be potentially more effective than adenosine alone. There may also be a role for prophylactic IC nitroprusside in patients at high-risk of developing no-reflow with PCI (e.g. Decompensated heart failure/left ventricular dysfunction When delivered IC, verapamil, nicardipine, and diltiazem are all effective vasodilators of the coronary microcirculation.
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