Forwards or backwards vasoactives?

Here's a post from my colleague at work and guest author on this site. Dr Steven Lim:


An 85 year old with symptomatic critical aortic stenosis was uptriaged to resus because of abnormal ECG. She appears comfortable and not in pain. Thankfully, ECG is similar to previous ones.
Questions to ponder:
1. What are the drugs which can destabilise AS?
2. What can you give if she has chest pain?
3. She has been considered for TAVI, what's that?


1. Diuretics, Vasodilators, Inotropic agents like dobutamine.
Remember, dobutamine "pumps downhill".
2. Nitrates (venodilator) may drop the BP. Consider analgesia.
Give O2, bed rest and treat BP cautiously (some use ACEI).
3. TAVI stands for transcatheter aortic valve implantation. A nice video is here: