No coronary artery occlusion in septic shock: Isoproterenol infusion should not be discouraged

Dear Editor, the recent report on “Isoproterenol infusion in septic shock” is very interesting (1). Wiramus et al. concluded that “use of isoproterenol was associated with an increase of tissue oxygen saturation (1).” In fact, there are some issues of isoproterenol use to be discussed. First, the increased heart rate due to infusion is common (2). On the other hand, the occurrence of paradoxical bradycardia can also be observed (3). In addition, the possibility of occurrence of isoproterenol-induced myocardial infarction should be kept in mind (4). The fatal case due to the infusion is reported in the literature (5). To prevent cardiac toxicity due to isoproterenol infusion, careful evaluation before usage is required. REFERENCES