Which inotrope is commonly used to augment cardiac output in cardiogenic shock?

• A. Dobutamine
• B. Milrinone
• C. Dopamine
• D. Epinephrine

Answer: (A)

In cardiogenic shock, the goal is to raise cardiac output by boosting the heart’s pumping strength while avoiding excessive vasoconstriction or oxygen demand. Dobutamine fits this well because it is mainly a beta-1 agonist with some beta-2 activity, which increases myocardial contractility and also causes mild vasodilation. This combination improves stroke volume and cardiac output and tends to lower afterload a bit, making the heart work more efficiently without a large rise in heart rate or blood pressure that could worsen ischemia. Milrinone can be used when you need both inotropy and vasodilation, but its blood pressure-lowering effect can be problematic in hypotensive patients. Dopamine increases contractility as well but often raises afterload and carries a higher risk of tachyarrhythmias. Epinephrine is a strong inotrope and vasoconstrictor that can worsen myocardial oxygen demand and afterload, so it’s usually reserved for refractory cases.