From the Guidelines
Morphine is not typically recommended as a first-line treatment for right heart failure.
Key Considerations
- In cases of acute right ventricular failure with severe dyspnea, morphine may be considered at a low dose, such as 2.5-5 mg intravenously, to help reduce anxiety and discomfort 1.
- The dose should be titrated carefully to avoid respiratory depression, and its use should be limited to a short duration, typically less than 24 hours.
- It is essential to monitor the patient's respiratory status, blood pressure, and oxygen saturation closely while administering morphine in this setting 1.
- Additionally, other treatments, such as diuretics, vasodilators, and inotropes, should be prioritized to address the underlying cause of right heart failure.
Important Precautions
- Morphine should be used cautiously in patients with hypotension, bradycardia, advanced AV block, or CO2 retention 1.
- Routine use of opioids in AHF patients is not recommended, and morphine use has been associated with higher rates of mechanical ventilation, ICU admission, and death 1.
- The decision to use morphine should be individualized, and its use should be limited to patients with severe symptoms who may benefit from its venodilatory and anxiolytic effects 1.
From the Research
Role of Morphine in Right Heart Failure
- Morphine is used to alleviate symptoms in patients with heart failure, including right heart failure 2, 3, 4, 5
- The evidence for morphine therapy in right heart failure is limited, and most studies focus on acute heart failure or chronic heart failure in general 6
- Morphine may be effective in relieving dyspnea in patients with advanced heart failure, including those with right heart failure 3, 5
- However, morphine therapy has been associated with increased risk of invasive ventilation, in-hospital mortality, and other adverse outcomes in patients with acute heart failure 2, 4
Mechanism of Action
- Morphine has vasodilatory properties, which can help reduce pulmonary vascular resistance and improve right ventricular function 2
- Morphine also has anxiolytic effects, which can help reduce symptoms of anxiety and dyspnea in patients with heart failure 3, 5
Safety and Efficacy
- The safety and efficacy of morphine in patients with right heart failure are not well established, and more research is needed to determine its role in this population 6, 2, 3, 4, 5
- Morphine should be used with caution in patients with right heart failure, and its use should be carefully monitored to minimize the risk of adverse outcomes 2, 4