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David S, Zaks JM. Arrhythmias associated with intermittent outpatient dobutamine infusion. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed. Review Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. Epub Jan Left ventricular assist devices: an evidence-based analysis. Medical Advisory Secretariat.. Ont Health Technol Assess Ser. Epub Mar 1. Magnetic resonance imaging MRI for the assessment of myocardial viability: an evidence-based analysis.
There have been a few studies that look at the use and effectiveness of dobutamine in the setting of hypotension 1, 2, 9, 10, 12, It has been proposed as a first line treatment for sepsis patients if used in conjunction with another vasopressor example: norepinephrine to prevent the reflexive SVR decrease and hypotension.
In the absence of using multiple vasopressors, dopamine and norepinephrine have been listed as the first line drugs of choice for septic shock patients.
However, dobutamine is the recommended inotropic agent to be used in combination to improve cardiac output without going to supranormal levels of cardiac output 3. But what if this patient has a bad heart? The evidence for use of dobutamine in patients with cardiogenic shock is more favorable 7, 12, Patients who need inotropic support primarily are recommended to undergo dobutamine therapy as their vasopressor of choice in the beginning.
This is due to the positive effect that dobutamine has on the contractility of the heart muscle itself. It has been shown as well that dobutamine appears to have a more favorable effect on right ventricular RV contractility than on left ventricular LV though it is effective in both settings What does all this mean? Well what this means is that the intern may have, in fact, been correct to suggest that we use dobutamine for our now hypotensive patient.
It all depends on the suspected cause IE: cardiogenic vs septic vs other causes of hypotension. The increase in stroke output is usually accompanied by a proportional decrease in systemic vascular resistance baroreceptor-mediated , and thus the arterial blood pressure usually remains unchanged.
The drug is effective in both right- and left-sided heart failure. The inotropic and chronotropic effects of dobutamine can vary widely in critically ill patients. This is partly due to variable pharmacokinetics and partly due to variable end-organ responsiveness. Elderly patients are relatively resistant to dobutamine and can have only half the inotropic responsiveness seen in younger patients.
The variable response to dobutamine in critically ill patients emphasizes the need to guide dobutamine therapy by preselected hemodynamic end-points, not by preselected dose rates. As mentioned, dobutamine is the preferred inotropic agent for the acute management of low output states due to systolic heart failure. Because dobutamine does not usually raise the arterial blood pressure, it is not indicated as monotherapy in patients with cardiogenic shock.
Dobutamine is also used in patients with septic shock and multiple organ failure who may have a normal cardiac output. These conditions are often accompanied by hypermetabolism, and in this situation, a normal cardiac output may be not be adequate for the increased oxygen requirements of hypermetabolism.
The goal of dobutamine therapy in these conditions is to drive the cardiac output to supranormal levels e. When the transducer is placed on the chest at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures.
The transducer picks up the reflected waves and sends them to a computer. The computer displays the echoes as images of the heart walls and valves. M-mode echocardiogram. This is the simplest type of echocardiogram.
It produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart's pumping chambers, the size of the heart itself, and the thickness of the heart walls. Doppler echocardiogram. This technique is used to measure and assess the flow of blood through the heart's chambers and valves.
The amount of blood pumped out with each beat is a sign of how well the heart is working. Also, Doppler can detect abnormal blood flow within the heart, which can mean there is a problem with one or more of the heart's valves or with the heart's walls.
Color Doppler. Color Doppler is an enhanced form of a Doppler echocardiogram. With color Doppler, different colors are used to show the direction of blood flow. This technique is used to see the actual structures and motion of the heart structures. A 2-D echo view looks cone-shaped on the monitor, and the real-time motion of the heart's structures can be seen. This allows the doctor to see the various heart structures at work and evaluate them.
The live or "real time" images allow for a more accurate assessment of heart function by using measurements taken while the heart is beating. To determine limits for safe exercise before you start a cardiac rehabilitation program or are recovering from a cardiac event, such as a heart attack myocardial infarction, or MI or heart surgery.
There may be other risks depending on your specific medical condition.
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