Dobutamine in the rejecting transplanted heart.

Dopamine is commonly used to improve cardiac output and to maintain peripheral perfusion after myocardial injury. It has several advantages over other catecholamines. At effective inotropic dose levels, dopamine produces less peripheral vasoconstriction than norepinephrine. Dopamine also causes fewer arrhythmias than isoproterenol. This is a case report of a heart transplant patient who began rejecting and developed heart failure. In addition to the immunosuppressive agents, dopamine was used initially as the vasopressor with marked deterioration in the patient's condition. Dobutamine, a new inotropic agent, was substituted for dopamine with subsequent improvement in cardiac function. The authors concluded that dobutamine may be the most appropriate agent to use in the rejecting transplanted heart because of the former's direct action on the heart. Dobutamine may also be preferred for support of the cardiac outputs of patients with chronic heart failure.