Milrinone Explained: The Inotrope for Beta-Blocked Hearts

Описание: Milrinone is a phosphodiesterase-3 inhibitor and the go-to inotrope when patients are on beta-blockers or have right ventricular failure. In this deep dive, we cover the pharmacology, mechanism, clinical applications, and critical differences between milrinone and dobutamine.

🎯 What You'll Learn:
• PDE-3 inhibition mechanism (non-adrenergic)
• Why milrinone works despite beta-blockade
• Inodilator profile: inotropy + vasodilation
• Milrinone vs dobutamine: when to choose which
• Use in cardiogenic shock and ADHF
• Right ventricular failure and pulmonary vasodilation
• Dosing and renal adjustments
• PROMISE trial and chronic use dangers
• Thrombocytopenia monitoring
• Combining with vasopressors (NE)
• MCS considerations (ECMO, Impella, IABP)

⚠️ Key Takeaways:
✓ Works independently of beta receptors (PDE-3 inhibitor)
✓ First-line inotrope for beta-blocked patients
✓ Reduces both SVR and PVR (afterload reduction)
✓ Longer half-life than dobutamine (harder to wean)
✗ Hypotension risk (often needs concurrent NE)
✗ Chronic use increases mortality (PROMISE trial)
✗ Thrombocytopenia in 2-4% of patients


🔬 Evidence-Based Critical Care Education
Designed for ICU physicians, cardiology fellows, critical care NPs/PAs, nurses, pharmacists, and cardiovascular specialists.
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🩺 PULSE & PRESSORS
Where critical care gets crystal clear.
Reflecting on the marvels of the human body.


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