0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
28 Acute Heart Failure➣Relative Contraindications: stroke, hypotension, severe anemia,
significant valvular stenosis, restrictive or obstructive cardiomy-
opathy, constrictive pericarditis, pericardial tamponade, or other
conditions in which cardiac output is dependent upon venous
return, or for patients suspected to have low cardiac filling pres-
sures
■Dobutamine: intravenous; requires blood pressure and ECG moni-
toring
➣Indication: Increases myocardial contractility, mildly reduces
preload, mild afterload reduction
➣Side Effects and Complications: arrhythmias, hypotension,
asthma exacerbation, nausea/ vomiting, headache, angina,
thrombocytopenia, local injection site reaction
➣Absolute Contraindications: IHSS, severe obstructive valvular
disease
➣Relative Contraindications: hypertension, recent MI, arrhyth-
mia, volume depletion
■Milrinone: intravenous, many centers no longer use bolus dose
to avoid hypotension; requires careful blood pressure and ECG
monitoring; may consider if patient on a beta-blocker.
➣Indication: Increases myocardial contractility, mildly reduces
preload, afterload reduction
➣Side Effects and Complications: arrhythmias, hypotension, nau-
sea/ vomiting, headache, angina, myocardial infarction, local
injection site reaction
➣Absolute Contraindications: IHSS, severe obstructive valvular
disease, myocardial infarction
➣Relative Contraindications: hypertension, arrhythmia, volume
depletion
■Dopamine: IV, low dose for “renal effects”; requires careful blood
pressure and ECG monitoring
➣Indication: Increases myocardial contractility, mildly reduces
preload, afterload reduction
➣Side Effects and Complications: arrhythmias, hypotension, nau-
sea/ vomiting, headache, angina, myocardial infarction, local
necrosis at injection site reaction
➣Absolute Contraindications: pheochromocytoma, IHSS, severe
obstructive valvular disease
➣Relative Contraindications: hypertension, arrhythmia, volume
depletion, myocardial infarction, severe peripheral vascular dis-
ease