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Specifically, in patients experiencing inadequate blood perfusion (with blood pressure below 80 mmHg), the American Heart Association / American College of Cardiology (ACC/AHA), recommends the use of Dobutamine and Milrinone. [75] Whereas in clinically stable patients with sufficient perfusion, cardiac inotrope use is advised against. [76]
Milrinone, one of the first PDE3 inhibitors used clinically A PDE3 inhibitor is a drug which inhibits the action of the phosphodiesterase enzyme PDE3 . They are used for the therapy of acute heart failure and cardiogenic shock .
Milrinone is a commonly used therapy for severe pulmonary arterial hypertension (PAH), [14] often in combination with other medications such as sildenafil. [15] Targeting PDE3 with optimal doses and timing, milrinone prevents allergic inflammation in HDM-driven models of allergic airway inflammation.
There is a long-standing controversy regarding whether the drug actually increases cardiac contractility in diseased myocardium (and therefore whether it is of any clinical use). The issue has been reviewed extensively by Dr Peter Wilmshurst , one of the first cardiologists and researchers to question the drug's efficacy.
Dobutamine is a medication used in the treatment of cardiogenic shock (as a result of inadequate tissue perfusion) and severe heart failure. [2] [3] It may also be used in certain types of cardiac stress tests. [2] It is given by IV only, as an injection into a vein or intraosseous as a continuous infusion. [2]
Sympathomimetic drugs are used to treat cardiac arrest and low blood pressure, or even delay premature labor, among other things. These drugs can act through several mechanisms, such as directly activating postsynaptic receptors , blocking breakdown and reuptake of certain neurotransmitters, or stimulating production and release of catecholamines.
It is not used often, as more established drugs like epinephrine, dopamine, dobutamine, norepinephrine, and levosimendan work as well. It works by stimulating beta-2 adrenergic receptors and peripheral dopamine receptor D1 and dopamine receptor D2. It also inhibits the neuronal re-uptake of norepinephrine.
A cardiac stimulant is a drug which acts as a stimulant of the heart – e.g., via positive chronotropic action (increased heart rate) and/or inotropic action (increased myocardial contractility). They increase cardiac output (the amount of blood pumped by the heart over time).