The Slow Rhythm of Midodrine: A Peculiar Case of Profound Bradycardia

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Case Report

Publication Date

5-30-2022

Keywords

Hypovolemic Shock, Critical Care Medicine, Refractory Hypotension, Midodrine-Induced bradycardia, Reflex bradycardia, Case Report

Disciplines

Anesthesiology | Critical Care | Internal Medicine

Abstract

Shock is a state of decreased organ perfusion that is life-threatening and requires emergent medical intervention [1]. As such, patients who present with shock are often managed in the critical care unit with intravenous fluid boluses and vasoactive agents. The ultimate goal is to prevent multi-system organ failure and to achieve a mean arterial pressure >65mmHg. Oral Midodrine has been hailed as an adjunctive therapy in critical care patients with refractory hypotension [2, 3, 4, 5]. However, Midodrine is only FDA approved, and remains the sole treatment for symptomatic orthostatic hypotension [6]. The mechanism of action is through alpha-1 adrenergic activation leading to an increase in vascular tone [2, 3, 4, 5]. Midodrine does not stimulate cardiac beta-adrenergic receptors, however its use can result in profound bradycardia [6]. We present a case of a 53-year-old patient in hypovolemic shock, refractory to fluid resuscitation who developed profound bradycardia after the initiation of Midodrine. This case highlights an overlooked and potentially dangerous side effect of a commonly used, off-label indication for this medication.

Publisher or Conference

International Journal of Clinical Studies & Medical Case Reports

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