J Cardiovasc Interv.  2025 Apr;4(2):120-129. 10.54912/jci.2024.0030.

Optimal Inotrope and Vasopressor Therapy in Cardiogenic Shock

• Bae DH

• KMID: 2566686
• DOI: http://doi.org/10.54912/jci.2024.0030

Abstract

Cardiogenic shock is a life-threatening condition characterized by inadequate organ perfusion due to reduced cardiac output, necessitating immediate intervention. Inotropes such as dobutamine and milrinone are used to enhance cardiac output, while vasopressors such as norepinephrine increase systemic vascular resistance to maintain organ perfusion. The updated classification by the Society for Cardiovascular Angiography and Interventions stratifies the severity of cardiogenic shock and aids in therapeutic decisions. Although these agents effectively stabilize hemodynamics, their prolonged use is associated with adverse outcomes, including arrhythmias and ischemia. No significant differences in mortality have been observed between the various inotropes and vasopressors; however, careful individualized therapy based on continuous hemodynamic monitoring is crucial. The potential toxicity associated with high-dose catecholamines underscores the importance of minimizing their use by employing the lowest effective dose and considering mechanical circulatory support when necessary. Advancements in pharmacological management and standardized monitoring protocols are essential to improve survival and reduce complications in cardiogenic shock management.

Keyword

Cardiogenic shock; hemodynamics; Vasoconstrictor agents