Major Goals in Treating Cardiogenic Shock:

 load reduction

 preservation of cardiac function

 maintenance of an optimal BP so as to promote renal perfusion.

European Heart J ournal, Volume 40, Issue 32, 21 August 2019, Pages 2671–2683, https://doi.org/10.1093/eurheartj/ehz363
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1. Inotropes (Dobutamine, Dopamine)

a. Dobutamine

The standard intravenous dose is 2.5 to 10 mcg/kg/min, with lower doses (2.5-5 mcg/kg/min)

frequently sufficient,and rarely up to 40 mcg/kg/min.It can be infused for up to 72 hours with

monitoring.

Indications: acute-on-chronic refractory heart failure, severe AMI (after cardiac surgery),
 cardiogenic shock, and excess b-blockade.

b. Dopamine

Dopamine can only be given intravenously, which restricts its use to short-term treatment.The

dose starts at 0.5 to 1 mcg /kg/min and is increased until an acceptable urinary flow, BP, or heart

rate is achieved; vasoconstriction begins at approximately 10 mcg/kg/min

In cardiogenic shock, infusion of equal concentrations of dopamine and dobuta- mine may afford more

advantages than either drug singly

2. Vasopressor (Norepinephrine)

Norepinephrine has prominent b1- and a-effects with less b2-stimulation, given in an intravenous dose of
 8 to 12 mcg/min with a terminal half-life of 3 minutes. It should be of most use when a shocklike state is

accompanied by peripheral vasodilation (“warm shock”).

Side effects of norepinephrine include headache,tachycardia,bradycardia,and hypertension

Contraindications include late pregnancy and preexisting excess vasoconstriction.

3. IABP

An intra-aortic balloon pump is a long, skinny balloon that controls the flow of blood through the aorta.

The device gets smaller when heart pumps so blood can flow out to the rest of your body. Then it gets

bigger when heart relaxes to keep more blood in the heart.