Which class of tocolytics should be avoided in Marfan syndrome due to increasing heart rate?

Which class of tocolytics should be avoided in Marfan syndrome due to increasing heart rate?

• A. Beta-adrenergic tocolytics
• B. Beta-blockers
• C. Calcium channel blockers
• D. Prostaglandin inhibitors

Answer: (A)

In Marfan syndrome, the aorta is often weakened and prone to dilation and dissection. Raising the heart rate and overall cardiac workload increases shear stress on the aortic wall, heightening the risk of dissection. Beta-adrenergic tocolytics do exactly that—they stimulate beta receptors to relax the uterus but also increase heart rate and contractility. Because of the potential to worsen a dangerous aortic condition, this class should be avoided for tocolysis in patients with Marfan syndrome. Other tocolytics do not carry the same heart-rate–driving effect, so they are typically preferred, with choices guided by the overall maternal-fetal context.

In Marfan syndrome, the aorta is often weakened and prone to dilation and dissection. Raising the heart rate and overall cardiac workload increases shear stress on the aortic wall, heightening the risk of dissection. Beta-adrenergic tocolytics do exactly that—they stimulate beta receptors to relax the uterus but also increase heart rate and contractility. Because of the potential to worsen a dangerous aortic condition, this class should be avoided for tocolysis in patients with Marfan syndrome. Other tocolytics do not carry the same heart-rate–driving effect, so they are typically preferred, with choices guided by the overall maternal-fetal context.