Vasodilators for mitral valve regurgitation
Examples
Generic Name Brand Name hydralazine hydrochloride Apresazide [contains a diuretic], Apresoline Angiotensin-converting enzyme (ACE) inhibitors:
Generic Name Brand Name benazepril Lotensin captopril Capoten enalapril Vasotec fosinopril Monopril lisinopril Prinivil, Zestril quinapril Accupril ramipril Altace trandolapril Mavik Nitrates:
Generic Name Brand Name nitroprusside (used in acute MR) Nipride, Nitropress How It Works
Vasodilators work on different substances in the body to help widen (dilate) blood vessels.
Why It Is Used
Vasodilators are used for mitral valve regurgitation (MR) because the wider blood vessel will reduce resistance in blood flow and make it easier for blood to move forward from the left atrium to the left ventricle to the aorta. This helps reduce the amount of blood that leaks backward through the valve into the left atrium.
How Well It Works
Data support the use of vasodilators in those with acute and chronic MR when the left ventricle is enlarged. However, there are no data to support using vasodilators in mitral valve regurgitation with no symptoms or with normal ventricular function.1
Side Effects
Hydralazine may lower blood pressure, which may cause symptoms of dizziness, weakness, fainting, or fluid retention. People whose blood pressure is low when they start therapy will generally be started with a low dose and may need close monitoring to avoid reducing blood pressure too much. Hydralazine may also result in an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); numbness, tingling, pain, or weakness of arms or legs; irregular or very fast heartbeat; new or worsening chest pain; or fainting.
ACE inhibitors may cause a dry cough, allergy symptoms, rash or itching, allergic reaction with generalized swelling (angioedema), and excess potassium in the body (hyperkalemia), especially in people with kidney failure.
ACE inhibitors may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium.
Nitroprusside may cause severe low blood pressure leading to death. Using too much too quickly may result in cyanide levels that the body cannot dispose of, leading to cyanide poisoning. Nitroprusside is generally only used in acute mitral regurgitation in patients who are hospitalized.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Nitroprusside should not be used in acute MR if the person with MR already has low blood pressure, because this medication may further decrease blood pressure.
ACE inhibitors must be used carefully in people with severe kidney failure caused by diabetic nephropathy. A low dose is tried first. Potassium levels and kidney function are watched closely as the dose is increased.
Although vasodilators are used in acute MR, the benefits of using them for chronic MR are less clear.2
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| Author: | Kathe Gallagher, MSW Cynthia Tank | Last Updated: April 3, 2006 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |