Em pacientes com MÁ perfusão, não está indicada diureticoterapia. Segundo UTD, está indicado principalmente inotrópicos, e podem ser considerados vasodilatadores e até vasopressores, a depender dos níveis pressóricos.

Segue:
If the systolic blood pressure is <85 mmHg or there is evidence of shock (eg, cool extremities, narrow pulse pressure, low urine output, confusion) and evidence of adequate preload, the addition of an inotrope is suggested [19]. In patients with persistent shock, a vasopressor may be needed as a temporizing measure to support perfusion to vital organs, though this is at the expense of increased LV afterload. Selected patients with hypotension may benefit from vasodilator therapy guided by invasive monitoring, including pulmonary artery catheter.
https://www.uptodate.com/contents/treatment-of-acute-decompensated-heart-failure-specific-therapies?search=insufici%C3%AAncia%20card%C3%ADaca%20descompensada&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=2#H12957960