Critical Care and Shock

Case report: methylene blue for cardiogenic shock

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Background: Cardiogenic shock after acute myocardial infarction is a cause of elevated morbidity and mortality in coronary intensive care units. The pathophysiology of cardiogenic shock involves both heart failure and increased afterload, but sometimes, not frequently may present as a vasodilatory state secondary to systemic inflammation, which requires treatment with high doses of inotropics and vasopressors.

Objective: We present 3 cases of patients with myocardial infarction who developed cardiogenic shock resistant to vasopressors, who were treated with methylene blue and who showed improved clinical outcomes.

Data sources: Several studies have demonstrated that methylene blue increases systemic vascular resistance reflected by an increase in mean arterial pressure, or from a reduction in vasopressors requirements in patients with septic shock. It also improves myocardial contractility and oxygen delivery, although this is controversial. There is evidence that an inflammatory response with activation of inducible nitric oxide synthase might be responsible for the deleterious effects and persistent vasodilation in patients with cardiogenic shock resistant to vasopressors.

Conclusions: We review briefly the changing paradigm in the use of nitric oxide antagonists in treating patients suffering cardiogenic shock.

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