Mx

alpha-1 agonists such as dobutamine HCl is 1st line in cardiogenic shock

Acute pulmonary edema who does not respond to IV furosemide, nitrates, and morphine (those drugs reduce preload) are given dobutamine, which acts as a positive inotrope and decreases afterload, thus increasing the cardiac output.

however, dobutamine can cause hypotension because of reduced afterload. Dopamine should be used in that case which has a pressor effect and increases afterload.

If the patient does not respond to dobutamine and has an adequate BP, then hydralazine can be administered.

Hydralazine also acts by reducing afterload. However, because of its side effects (SLE like syndrome), it is 2nd line to dobutamine

Intra-aortic Balloon Pump (IABP)

place distal to left subclavian artery, but proximal to renal arteries (may see oliguria if too distal and occlude them)

inflates with diastole and deflates with early systole; beat to beat (1:1) or less often such as 1:2, 1:4 or 1:8

creates Windkessel effect

Cons

Can be thrombogenic; can cause haemolysis

Contraindicated in AR, dissection and aneurysm