Pump Failure/Poor LV Function

• Norepinephrine as initial vasopressor
  • Improved DBP and myocardial perfusion may improve LV function
• If persistent myocardial dysfunction add inotrope (e.g. epinephrine 0.01-0.08 mcg/kg/min)
  • Titrate to myocardial function on bedside US
• Consider sepsis induced myocardial dysfunction – Low threshold for empiric Abx

 

Aortic Stenosis

• Needs more afterload without tachycardia – phenhylephrine or vasopressin

 

Mitral stenosis

• Preload dependent