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The selective β1 agonist that has been most widely used in patients with heart failure is dobutamine. This parenteral drug produces an increase in cardiac output together with a decrease in ventricu-lar filling pressure. Some tachycardia and an increase in myocar-dial oxygen consumption have been reported. Therefore, the potential for producing angina or arrhythmias in patients with coronary artery disease is significant, as is the tachyphylaxis that accompanies the use of any β stimulant. Intermittent dobutamine infusion may benefit some patients with chronic heart failure.
Dopamine has also been used in acute heart failure and may be particularly helpful if there is a need to raise blood pressure.
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