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Midodrine in end-stage heart failure
  1. Ariel Gonzalez-Cordero1,2,
  2. Stephanie Ortiz-Troche2,
  3. Juan Nieves-Rivera3,
  4. Marcel Mesa-Pabón3 and
  5. Hilton Franqui-Rivera3
  1. 1 Internal Medicine Department, University of Puerto Rico, San Juan, Puerto Rico, Puerto Rico
  2. 2 School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
  3. 3 Medicine Department, Cardiology Division, UPR, San Juan, Puerto Rico
  1. Correspondence to Dr Ariel Gonzalez-Cordero, Internal Medicine, University of Puerto Rico, San Juan 00927, Puerto Rico; arielgonzalezcordero{at}


It is estimated that 5% of patients with heart failure (HF) will progress to end-stage disease refractory to medical therapy and might require prolonged hospitalisation with inotropic support. We present the case of a patient with end-stage HF who was admitted with cardiogenic shock. During his hospitalisation, he required prolonged intravenous vasopressor therapy due to refractory hypotension. He did not qualify for heart transplantation or left ventricular-assist device strategies. Midodrine was started as a last resort attempt to wean off vasopressors. After 5 days of therapy, the patient was weaned entirely off vasopressors and was discharged home for hospice care. By the time of discharge, he was tolerating low-dose carvedilol along with midodrine. We propose midodrine as a reasonable alternative for patients with end-stage HF with reduced ejection fraction and refractory hypotension, who are dependent on intravenous vasoactive drugs and are not candidates for advanced HF therapies.

  • heart failure
  • end of life care
  • hospice care
  • hospital care

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The author declares that there is no private funding or conflict of interest to disclose. Case abstract has been published and presented elsewhere.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.