Mike, I'd respond in the Clinical section of the forum regarding your patient with pulmonary hypertension but can't post there. You commented on your use of Milrinone in PH patients:

Quote Originally Posted by MmacFN View Post
The reason i used it has nothing to do with the ECHO. Milrinone Improves Pulmonary Hemodynamics and Right Ventricular Function never gonna be a bad thing in PH patients who are moderate to severe.

The goals of management 2,3,5 and 6 can be assisted with the use of milnarone on these patients.

1) Preload: Maintenance of preload (intravascular volume) at normal or increased levels is essential to
maintain cardiac output in the face of increased RV afterload.


2) Systemic vascular resistance (SVR): In normal hemodynamic states, SVR is a major determinant of LV
afterload (and, therefore, cardiac output). In PH, cardiac output is limited by RV function and is therefore
independent of SVR. In order to avoid systemic hypotension, SVR must be maintained in the normal-to-high range.

3) Contractility: Maintenance of normal-to-high contractility is essential to maintain cardiac output in the
face of increased RV afterload.

4) Heart rate and rhythm: Sinus rhythm is important for adequate filling of a hypertrophied right ventricle.
Stroke volume is limited by ventricular afterload, so bradycardia should be avoided.

5) Avoidance of myocardial ischemia: Right ventricular subendocardial ischemia due to myocardial oxygen
supply-demand imbalance is common in PH. Systemic hypotension and excessive increases in preload, contractility,
and heart rate must be avoided.

6) Pulmonary vascular resistance: In PH, PVR is the major factor governing RV afterload and cardiac
output. Therefore, increases in PVR must be avoided and therapy to decrease PVR may be required.
Isn't the use of Milrinone contrary to #2?