A 45-year-old man with chronic alcoholic cardiomyopathy (LVEF 20%) presents with acute decompensated heart failure. Blood pressure is 88/60 mmHg, pulse 118 bpm, cold extremities, and lactate 3.8 mmol/L. Which inotrope is preferred in this hypotensive patient with signs of hypoperfusion?

• A Dopamine
• B Milrinone
• C Digoxin
• D Dobutamine ✓

Explanation

Dobutamine is the preferred inotrope in acute decompensated HF with hypotension and hypoperfusion because it increases cardiac output via beta-1 stimulation with relatively modest vasodilatory effect compared to milrinone. Milrinone is a phosphodiesterase-3 inhibitor with significant vasodilatory properties that can worsen hypotension. Dopamine at inotropic doses increases arrhythmia risk and mortality compared to dobutamine. Digoxin is not an acute inotrope and has no role in cardiogenic shock.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.