Severe tachycardia induced by dopamine in an elderly patient with renal insufficiency: A case report and literature review

RATIONALE: Dopamine remains a widely used inotrope in acute heart failure and cardiorenal syndrome; however, its administration carries a substantial risk in vulnerable patients. Current evidence suggests that conventional dosing strategies may lead to adverse cardiovascular outcomes. Here, we report a case highlighting the importance of conservative dopamine titration and structured monitoring to optimize both efficacy and safety. PATIENT CONCERNS: A high-risk patient with acute decompensated heart failure presented with progressive dyspnea, oliguria, and hypotension. The patient exhibited significant hemodynamic instability, raising concerns about the use of dopamine as an inotropic agent. DIAGNOSES: The clinical evaluation supported a diagnosis of acute decompensated heart failure with concurrent cardiorenal syndrome based on reduced urine output, elevated creatinine levels, pulmonary congestion, and echocardiographic findings. INTERVENTIONS: Dopamine infusion was initiated at a conservative starting dose (≤1.5 μg/kg/min), During subsequent cautious upward titration, the patient developed symptomatic tachyarrhythmia, prompting immediate discontinuation of the infusion. Patient management was guided by a structured monitoring pathway, incorporating bedside clinical assessment, pharmacist input, and electronic clinical decision support. OUTCOMES: The initial dopamine infusion improved urine output and stabilized systemic blood pressure. However, during dose titration, the patient developed a symptomatic tachyarrhythmia with ventricular rates reaching 180 bpm, classified as a "probable" adverse drug reaction. Upon discontinuation of dopamine and with careful hemodynamic management, the arrhythmia resolved. The heart rate subsequently decreased from a pretreatment baseline of 106 beats/min to a safer range, underscoring the necessity of vigilant monitoring even with conservative initial dosing. LESSONS: This case emphasizes that dopamine therapy should not follow a "one-size-fits-all" model. Conservative dosing, multidisciplinary monitoring, and the use of decision support tools can reduce medication errors and improve safety. Personalized inotrope strategies are essential in patients with high-risk heart failure patients.