A patient enters the ICU after a redo repair of ascending aortic aneurysm, and total arch replacement. He is in cardiogenic shock with unstable hemodynamics. Another patient has been doing well after a straight forward aortic valve replacement, and has been on no vasoactive medications, but has become increasingly pale and cold. Urine output is down, but he is hypertensive. A third patient arrested on the step down unit, and was resuscitated. She transfers to your ICU and needs to be stabilized. First line therapy for all of these patients will be vasoactive medications. Unfortunately, choosing the best fit for each patient is not always straight forward.