Dobutamine/norepinephrine

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Lack of efficacy: case report A 72-year-old man experienced lack of efficacy during treatment with dobutamine and norepinephrine for cardiogenic shock. The man, who had a history of non-ischaemic cardiomyopathy with poor left ventricular ejection fraction, was admitted with respiratory distress syndrome. A transthoracic echocardiography revealed mild aortic regurgitation. He was intubated and received unspecified treatment. On day 8 of admission, he developed cardiogenic shock and non-ST elevation myocardial infarction. He received intensive treatment with dobutamine 5 µg/kg/min and norepinephrine 0.32 µg/kg/min [routes not stated]. However, he remained haemodynamically compromised despite the intensive treatment, and his cardiogenic shock persisted with a systolic blood pressure of 80–90mm Hg and HR of 100–120 bpm. Subsequently, the man underwent placement of a heart pump (Impella 2.5) resulting in haemodynamic improvement. He then showed severe stenosis and underwent percutaneous coronary intervention. On day 9, his norepinephrine was tapered off. On day 10, weaning of the heart pump was initiated. He developed moderate aortic regurgitation owing to removal of the device. He showed moderate impairment of systolic function and moderate aortic regurgitation. On day 40, he was discharged without symptoms. Four weeks later, he was admitted again for progressive dyspnea on exertion. He showed recurrent heart failure due to aortic regurgitation. Hence, he underwent aortic valve replacement and showed uneventful post-operative recovery. Nishimura K, et al. Prosthetic valve replacement for aortic leaflet tear secondary to Impella device placement. Journal of Artificial Organs 23: 383-387, No. 4, Dec 2020. 803519985 Available from: URL: http://doi.org/10.1007/s10047-020-01191-y

0114-9954/20/1834-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 12 Dec 2020 No. 1834

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