Dobutamine/dopamine/vasopressin

Abstract

Lack of efficacy: case report In a case report of four patients, a 68-year-old man was described, who exhibited lack of efficacy during treatment with dopamine, vasopressin and dobutamine for hypotension. The man had a history of congestive heart failure, severe coronary artery disease, hypertension, diabetes mellitus, hyperlipidaemia, hypothyroidism and cerebrovascular accident with residual right-sided weakness. He had undergone multivessel coronary artery bypass surgery 19 years previously. Saphenous vein grafts had been utilised to bypass the right coronary artery (RCA), obtuse marginal and the left diagonal, and left internal mammary artery (LIMA) had been anastomosed in the left anterior descending (LAD) coronary artery. He had also received frequent percutaneous coronary interventions since his bypass. He presented to the emergency room with inferior ST elevation myocardial infarction and underwent cardiac catheterisation. Investigation showed 75% stenosis in left main coronary artery, total occlusions in the LAD ostium, proximal RCA and mid left circumflex. All saphenous vein bypass grafts were occluded and there was stenosis at the LIMA-LAD anastomosis. A Taxus stent was implanted in the LIMA-LAD anastomosis. Additionally, an intra-aortic balloon pump was placed. His hospital course was complicated by pneumonia with respiratory failure, hyperbilirubinaemia secondary to congestive heart failure and acute renal failure secondary to contrast nephropathy. Five days following admission, he developed hypotension. Therefore, he was treated with IV infusions of dopamine, vasopressin and dobutamine [dosages not stated]. However, despite maximal support, he died due to cardiac arrest. Therefore, lack of efficacy was considered for dopamine, vasopressin and dobutamine. Autopsy showed mild left ventricular hypertrophy, and acute and old several myocardial infarcts.