Authors: Nicole Ribeiro Marques MD, Felipe Medeiros MD, Destiny Chau MD– University of Arkansas for Medical Science/Arkansas Children’s Hospital, Little Rock


A 32-year-old woman with a history of interrupted aortic arch and complex left ventricular outflow tract (LVOT) obstruction status post aortic arch reconstruction and apico-aortic valved-conduit insertion presents for emergent exploratory laparotomy due to ruptured tubal pregnancy. Preoperative transthoracic echocardiogram demonstrated moderate obstruction at the native LVOT, LV hypertrophy and dilation with mildly diminished function and difficulty in visualizing the conduit. New-onset ST segment elevation in leads II and V are evident after anesthetic induction with the following vital signs: BP 88/38, HR 145, and SpO2 97%. Which medication is the MOST appropriate choice to manage this patient?