LV failure: Diagnosis and treatment post-CPB

Diagnosis:Low cardiac output in the context of adequate filling pressures

Treatment:Usually, LV dysfunction is amenable to inotropic therapy or combination therapy with positive inotropic and vasodilator agents to optimize cardiac output. Sympathomimetic amines (i.e., catecholamines such as epinephrine, norepinephrine, dopamine, and dobutamine) and phosphodiesterase inhibitors (e.g., milrinone) are commonly used as first-line therapy. Milrinone, an inodilator, improves cardiac output but significantly reduces SVR; concomitant use of an arterial vasoconstrictor is often necessary. Nitroglycerin is usually administered if ischemia is suspected. Occasionally, a mechanical assist device, such as an IABP or VAD, is necessary.