Temporary use of unusually high dose of catecholamine improved severe ventricular dysfunction associated with stunned myocardium without significant myocardial injury in a post cardiac surgical patient: A case report

Autor: Hakju Kim, Yoon Cheol Shin
Rok vydání: 2020
Předmět:
Zdroj: International Journal of Surgery Case Reports
ISSN: 2210-2612
DOI: 10.1016/j.ijscr.2020.10.013
Popis: Highlights • Temporary use of unusually high dose of catecholamines may help avoid unnecessary mechanical support after cardiac surgery. • In a stunned myocardium, increase of catecholamine over usual dose could be acceptable. • Short-term application of very high dose catecholamines under close monitoring may not be associated with poor outcome.
Introduction Some cardiac surgical patients present low cardiac output syndrome due to ventricular dysfunction resulting from postischemic myocardial stunning. We present a case of using unusually high dose of inotropes so that we could avoid mechanical circulatory support after cardiac surgery. Presentation of case A 65-year-old man underwent elective cardiac surgery. His immediate cardiac output was poor and vital signs were unstable. We aggressively increased the dose of catecholamine above usual dose and the cardiac output was elevated. The patient recovered without significant myocardial injury. After a few years, TTE showed more improved left ventricular function compared with preoperative state. Discussion In a stunned myocardium, response to catecholamine is thought to be dull. Thus, if adequate response to usual dose of catecholamine is not achieved in a post cardiac surgical patient, we think that there may be a room for more increment of inotropes. Conclusion Unusually high dose of catecholamine may be helpful in a patient with severe ventricular dysfunction associated with stunned myocardium.
Databáze: OpenAIRE