ABSTRACT
The majority of patients with post infarction cardiogenic shock will present with a normal to high PAWP, mild to moderate systemic hypotension, low to normal cardiac output and systemic hypoperfusion. Systemic hypoperfusion may occur in the presence of left ventricular filling pressures (PAWP) of 15 mmHg or more, systemic systolic pressures of between 70 and 100 mmHg and decreased stroke volume and cardiac output. Inotropic therapy aimed at improving ventricular contraction is the most direct and effective form of therapy in this subset of patients. Dobutamine is the preferred agent in these circumstances. In the presence of left ventricular dysfunction, high left ventricular filling pressures, mild to moderate hypotension and reduced peripheral perfusion, dobutamine (2-15 µg kg-1 min-1) improves ventricular performance, stroke volume and cardiac output, decreases ventricular filling pressures, normalizes systemic blood pressure, and improves peripheral perfusion. Dobutamine can be titrated by increments of 2-3 µg kg-1
min-1 every 15-30 min until the clinical targets are met. Milrinone, an agent with both inotropic and vasodilatory actions, can also reduce both left-and right-sided filling pressures while improving cardiac output.
