Counterpulsation and dobutamine. Their use in treatment of cardiogenic shock due to right ventricular infarct.

A patient had right ventricular infarction complicated by cardiogenic shock. Volume expansion along with high doses of dopamine hydrochloride successfully alleviated hypotension in this patient. However, he had persistent mental obtundation and low cardiac output, and adverse chronotropic responses to high doses of dopamine developed. Counterpulsation effectively maintained an adequate arterial pressure and dopamine therapy was discontinued. Counterpulsation, however, failed to augment cardiac output. Simultaneous use of dobutamine hydrochloride along with counterpulsation was associated with a noticeable increase in cardiac output. To our knowledge, this is the first reported case of right ventricular infarct complicated by shock in which the simultaneous use of counterpulsation and dobutamine therapy resulted in a substantial increase in cardiac output.