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.

ABSTRACT

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.