The correct answer is B!

This question is part of the Mayo Clinic Cardiology Board Review course.

A patient presents with severe heart failure and BP 90/60 mmHg with EF 33%. His cardiac index is 1.8 L/m/m². 

Q: What is the drug that will optimally improve his myocardial performance?

A) High dose dopamine (15 µg/kg/min)

B) Nitroprusside (correct)

C) Phenylephrine

D) Norepinephrine


This patient has high peripheral vascular resistance despite his low systemic pressure. All vasoconstrictors will decrease myocardial performance, which will negate the effect of the added B1 effect with high dose dopamine and norepinephrine.


Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440–2492.

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