Purpose: To decrease patient's heart rate and reduce r-r interval variability for improved image quality of coronary artery CTA.
Goal: Achieve a heart rate of 50-60bpm.
Contraindications:
· Congestive heart failure (CHF)
· Significant asthma or bronchospasm who have used an inhaler within the past 2 weeks
· Severe aortic stenosis
· Known hypersensitivity to metoprolol
· Systolic blood pressure less than 100 mm Hg
· Heart rate less than 60 bpm
Relative contraindications:
· 1st degree av block with pr >/= 0.24sec
Procedure: Oral Metoprolol
1. Obtain baseline heart rate and blood pressure. For all patients consider anxiety level, BMI, clinical and medical history before deciding on doses.
If
baseline > 60 bpm give metoprolol 50 mg orally.
If baseline > 65 bpm give metoprolol 50-100 mg orally.
If baseline > 70 bpm give metoprolol 100-150 mg orally.If baseline > 80 bpm give metoprolol 100-200 mg orally.
2. Check and document heart rate and bp q 15 minutes x 1 hour after oral metoprolol is given
Procedure: Intravenous Metoprolol
If heart rate > 60 bpm and bp >100 systolic 60 minutes after oral metolprolol then:
1. Give iv metoprolol 5mg iv slowly over two minutes; perform in CT room as half-life is short.
2. Monitor and record patient's heart rate q 1 minute and bp q 3 minutes x 6 minutes - use continuous monitoring.
3. Continue to administer 5mg iv metoprolol q 5 minutes until heart rate <60 bpm or cumulative iv dose equals 30mg or bp<100 systolic.
Post Scan Procedure:
1. After scan completed monitor patient's heart rate and blood pressure q 5 minutes x three and than q 15 minutes if iv metoprolol administered- use continuous ECG monitoring
2. Patients may be discharged when the following criteria are met: resting heart rate >55bpm, free of adverse effects from metoprolol. For iv metoprolol, document heart rate and blood pressure for at least 30 minutes post procedure.
3. Notify physician for hr <45 or if patient experiencing signs or symptoms of adverse effects such as: dizziness, lightheadedness, syncope, hypotension, bronchospasm, wheezing, difficulty breathing, shortness of breath, heart block.
If baseline > 65 bpm give metoprolol 50-100 mg orally.
If baseline > 70 bpm give metoprolol 100-150 mg orally.If baseline > 80 bpm give metoprolol 100-200 mg orally.
2. Check and document heart rate and bp q 15 minutes x 1 hour after oral metoprolol is given
Procedure: Intravenous Metoprolol
If heart rate > 60 bpm and bp >100 systolic 60 minutes after oral metolprolol then:
1. Give iv metoprolol 5mg iv slowly over two minutes; perform in CT room as half-life is short.
2. Monitor and record patient's heart rate q 1 minute and bp q 3 minutes x 6 minutes - use continuous monitoring.
3. Continue to administer 5mg iv metoprolol q 5 minutes until heart rate <60 bpm or cumulative iv dose equals 30mg or bp<100 systolic.
Post Scan Procedure:
1. After scan completed monitor patient's heart rate and blood pressure q 5 minutes x three and than q 15 minutes if iv metoprolol administered- use continuous ECG monitoring
2. Patients may be discharged when the following criteria are met: resting heart rate >55bpm, free of adverse effects from metoprolol. For iv metoprolol, document heart rate and blood pressure for at least 30 minutes post procedure.
3. Notify physician for hr <45 or if patient experiencing signs or symptoms of adverse effects such as: dizziness, lightheadedness, syncope, hypotension, bronchospasm, wheezing, difficulty breathing, shortness of breath, heart block.
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