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Cardiogenic Shock — EECC MCQ

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ModerateHeart FailureCardiogenic ShockEECC

A 75-year-old woman is admitted with acute pulmonary oedema. Her blood pressure is 82/50 mmHg, heart rate 120 bpm, and she has cold peripheries with mottled skin. Lactate is 5.6 mmol/L. Bedside echocardiography reveals severe global LV systolic dysfunction (LVEF 15%) with no significant valvular disease. Which inotrope is recommended as first-line in this scenario?

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Correct answer: C — Dobutamine

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

This patient has cardiogenic shock. Per the 2021 ESC HF Guidelines, dobutamine is recommended as first-line inotrope for cardiogenic shock to improve cardiac output. A vasopressor (noradrenaline) may be added if hypotension persists. Milrinone (A) causes more hypotension due to vasodilation. Levosimendan (B) also causes vasodilation and is less appropriate in hypotensive shock. Dopamine (D) is associated with more arrhythmias (SOAP II trial). Adrenaline (E) is associated with worse outcomes vs noradrenaline in cardiogenic shock.

Reference: ESC (2021): Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure