Monday, February 27, 2012

How Morphine Can Help in Heart Failure at the End of Life

Morphine is most often used as a pain reliever.  But for heart patients, it is often used for shortness of breath.  There are several ways that morphine interrupts the cycle of breathlessness.
  • Morphine lowers the breathing rate in the brain’s respiratory center. This means the heart doesn’t have to work so hard to supply blood to the chest muscles for breathing.  It reduces excessive breathing drive.
  • Morphine widens blood vessels in the arms and legs.  Pooling blood in the extremities reduces the amount of blood that returns to the heart.  This means the heart doesn’t have to pump as often—it can rest more.  When the heart doesn’t have to pump so hard, it also needs less oxygen—so the resident doesn’t have to breathe as hard.
  • It eases anxiety, and when a resident is less anxious, he or she will breathe more calmly.  If you breathe more slowly, you are less anxious.
  • When we are in pain, we tend to breathe faster and harder.  So relieving pain also reduces respiratory rate.
Used correctly, morphine is safe.  Addiction is very, very rare.  The chance of becoming addicted is so small that it is considered unethical to withhold morphine because of a fear of addiction.

But if we don’t know how opioids like morphine, fentanyl, Vicodin or Dilaudid work, we may mistake initial responses.  If an opiod is new to a person, he or she may be sleepy for the first 2 or 3 days—especially if they have not been sleeping well (maybe because of shortness of breath or pain).  When symptoms are relieved, the resident may want to “catch up” on sleep.  After a few days, the sleepiness wears off.

At the end of life, morphine is the most important medicine for providing comfort to heart patients.  It reduces the breathless feeling that can be so frightening to people at the end of life.

3 comments:

  1. Morphine should rarely (IF EVER) be used for heart issues. There was a recent study, supported by the U.S. National Institutes of Health, indicating morphine causes WORSE outcomes for heart conditions.

    http://www.ncbi.nlm.nih.gov/pubmed/18356349

    This is BAD! And do you know how I know? I was having an angina episode, went to the emergency room, they gave me morphine and my BARELY elevated heart rate (~85 / min) and modest blood pressure (115 / 70) collapsed. I went into FULL CORONARY FAILURE! This should have NEVER happened. And it was directly related to morphine.

    This post is dangerous....

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  2. We are really sorry that you had such a traumatic event occur during your treatment for angina in the emergency room. Our article is about heart failure, specifically at the end of life. We conclude that “At the end of life, morphine is the most important medicine for providing comfort to heart patients. It reduces the breathless feeling that can be so frightening to people at the end of life.” Pathways stands by this information which is a standard in hospice care for dying patients.

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  3. Really i like your post !!!! Thanks for sharing this informative information.
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