At home in Nigeria, they would present to the physicians for continue follow up. They return home after a brief stay of managing the acute condition in those hospitals. However, the world being a global village, many of our heart failure patients now travel oversea to seek more advanced medical care in other countries outside Nigeria. Outpatient dobutamine infusion for heart failure has not come into a routine practice and prescription in Nigeria medical practice. Long-term use of dobutamine infusion lessens the symptoms of CHF has not been shown to prolong survival but it reduces frequency of hospital admission. Because it may cause sudden death, patients receiving this therapy must be carefully monitored. Because the therapy has not been shown to prolong survival in most patients, specific endpoints of therapy could be determined for each patient. It also benefits patients with contra-indication to heart transplantation. It could be used in patients with refractory heart failure and that awaiting heart transplantation. Long-term dobutamine therapy could lessen the symptoms of CHF and improve exercise tolerance and cardiac function. Sustained effects have been seen with dobutamine infusions, although the known properties of the drug do not explain these effects. It is routinely administered for short periods to relieve exacerbations of congestive heart failure (CHF) in hospitalized patients. Its widespread use may be restricted by cost and expertise considerations in Nigeria Key wordsĭobutamine, refractory heart failure, long term use, home Backgroundĭobutamine increases cardiac contractility and causes vasodilation with little change in heart rate. He was discharged home on long term dobutamine infusion.Ĭonclusion: Home dobutamine is a simple and effective in term treatment for end-stage heart failure. He was treated for NYHA class IV heart failure with digoxin, and dobutamine and furosemide. The electrocardiogram showed pacemaker rhythms. Fine crepitations were heard over the posterior-basal regions of both lungs. A summation gallop was noted over the precordium. Peripheral pulses were threatened and diminished in amplitude, and his hands and feet were cool and moist. He was noted to be anxious and diaphoretic with a respiratory rate of 36 breaths/minute, blood pressure of 84/52 mm Hg, heart rate 80 beats/minute. He has more than 12 repeated hospital admissions for heart failure in the past 4 years despite having CRT-D.
He presented to the emergency department with 6 weeks history of bilateral leg swelling, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and oliguria. He was diagnosed with biventricular failure 6 years ago and had cardiac resynchronization therapy (CRT-D) implanted 4 years before the presentation. We reported an 86-year-old man with a refractory heart on long term dobutamine.Ĭase Summary: An 86-year-old retired civil servant living with hypertension for 26 years, type 2 Diabetes Mellitus (T2DM) for 14 years, and hyperlipidemia for 10 years. It has also been documented for use in the management of chronic heart failure. It used in the management of acute heart failure with cardiogenic shock or in patients with low blood pressure. Introduction: Dobutamine increases cardiac contractility and causes vasodilation with little change in heart rate.
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