A patient with signs of heart failure after MI has crackles and cool, clammy skin. Which medication is commonly administered to improve cardiac output?

• A. Admin of dobutamine
• B. Start nitroglycerin infusion only
• C. Administer dopamine
• D. Defibrillate

Answer: (A)

In this situation, the goal is to boost the heart’s ability to pump blood to improve perfusion when the heart is failing after a myocardial infarction. Dobutamine is a beta-1 agonist that increases myocardial contractility and stroke volume, which raises cardiac output. It often causes mild vasodilation that can lower afterload a bit, helping the heart eject blood more effectively without causing a large drop in blood pressure. This makes it a common and effective choice for improving cardiac output in cardiogenic shock or heart failure signs after MI, especially when the skin is cool and clammy and crackles indicate fluid in the lungs.

Starting nitroglycerin infusion only would reduce preload and can lower blood pressure further, potentially worsening perfusion in someone already in shock. Dopamine is another inotrope, but it tends to increase heart rate and myocardial oxygen demand and isn’t as selectively favorable for improving contractility as dobutamine in this scenario. Defibrillation is used to treat life-threatening rhythms like ventricular fibrillation or pulseless VT, not to improve cardiac output in this context.