Dobutamine myocardial infarction

Dobutamine is widely used to increase myocardial contractility, cardiac output, and stroke volume in the peri-operative period. It is less likely to increase heart rate than dopamine. There is evidence that dobutamine can increase both myocardial contractility and coronary blood flow. This makes it particularly suitable for use in patients with acute myocardial infarction. Dobutamine is also suitable for treating septic shock associated with increased filling pressures and impaired ventricular function. Owing to the competing a and 3 activity there is usually little change in mean arterial pressure. 

A 38-year-old white man with a history of coronary artery disease, myocardial infarction, coronary artery by-pass, alcoholism, and depression took a combined massive overdose of diltiazem and atenolol (24). He underwent cardiopulmonary resuscitation because of cardiac arrest bradycardia, hypotension, and oliguria followed and were resistant to intravenous pacing and multiple pharmacological interventions, including intravenous fluids, calcium, dopamine, dobutamine, adrenaline, prenalterol, and glucagon. Adequate mean arterial pressure and urine output were restored only after the addition of phenylephrine and transvenous pacing. He survived despite myocardial infarction and pneumonia. 

Dobutamine increases cardiac output after acute myocardial infarction without exacerbating myocardial infarction or ventricular dysrhythmias. However, a mild increase in heart rate often occurs, and occasionally a more marked tachycardia. 

Previtali M, Scelsi L, Sebastian R, Lanzarini L, Raisaro A, Klersy C. Feasibility, safety, and prognostic value of dobutamine stress echocardiography in patients > or = 70 years of age early after acute myocardial infarction. Am J Cardiol 2002 90(7) 792-5. 

Beckmann S, Bocksch W, Muller C, Schartl M. Does dobutamine stress echocardiography induce damage during via-bihty diagnosis of patients with chronic regional dysfunction after myocardial infarction J Am Soc Echocardiogr 1998 ll(2) 181-7. 

Waagstein F, Malek I, Hjalmarson AC. The use of dobutamine in myocardial infarction for reversal of the cardio-depressive effect of metoprolol. Br J Chn Pharmacol 1978 5(6) 515-21. 

Sicari R, Picano E, Landi R et al. Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. J Am Coll Cardiol 1997 29 254-260. 

Dobutamine (dobutrex, others) is indicated for the short-term treatment of cardiac decompensation post cardiac surgery or in patients with congestive heart failure or acute myocardial infarction. An infusion of dobutamine in combination with echocardiography is useful in the noninvasive assessment of patients with coronary artery disease stressing the heart with dobutamine may reveal cardiac abnormalities in selected patients. 

A 60-year-old woman is in the coronary care unit following an acute myocardial infarction. She has developed signs of pulmonary edema of rapidly increasing severity. Aminophylline, dobutamine, and digoxin can each... 

Dopamine also stimulates cardiac Pi-receptors through both direct and indirect mechanisms. It is used to correct hemodynamic imbalances induced by conditions such as shock, myocardial infarction, trauma, or congestive heart failure. As a catechol and primary amine, dopamine is rapidly metabolized by COMT and MAO and, similar to dobutamine, has a short duration of action with no oral activity. It is administered as an intravenous infusion. 

Reversible severe left ventricular systolic dysfunction with apical ballooning has abo been reported during dobutamine stress echocardiography [45, 46, 47, 48, 49, 50, 51, 52, 53, 54 ] and abo in one case after recovery from stress echocardiography [55 ]. In one case it occurred in a patient with previous orthotopic heart transplantation [56 ]. In another case it occurred in a patient who had had a subarachnoid haemorrhage [57 ], in which sympathetic nervous system activity b increased and in which acute myocardial infarction can abo occur. 

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