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Medications used include: diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone antagonists (e.g., spironolactone). Some medications which increase heart function, such as the positive inotrope milrinone, lead to increased death, and are contraindicated. [9] [10]
Milrinone, sold under the brand name Primacor, is a pulmonary vasodilator [2] used in patients who have heart failure. It is a phosphodiesterase 3 inhibitor that works to increase the heart's contractility and decrease pulmonary vascular resistance.
Amrinone, milrinone and enoximone are used clinically for short-term treatment of cardiac failure in the presence of cardiogenic shock. [1]PDE3 inhibitors are indicated as inotropics for the therapy of acute heart failure if catecholamines are ineffective. [2]
Amrinone, also known as inamrinone, and sold as Inocor, is a pyridine phosphodiesterase 3 inhibitor. [1] It is a drug that may improve the prognosis in patients with congestive heart failure. [2]
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]
PDE3 inhibitors like amrinone, milrinone, and pimobendan [1] [2] [3] Cardiac glycosides like digoxin [2] Other agents like hydralazine, levosimendan, and cannabinoids [3] Exercise is also a cardiac stimulant by increasing levels of the sympathomimetic catecholamines epinephrine and norepinephrine. [4] [5]
Vesnarinone is a cardiotonic agent. [1] A mixed phosphodiesterase 3 inhibitor and ion-channel modifier that has modest, dose-dependent, positive inotropic activity, but minimal negative chronotropic activity.
Both positive and negative inotropes are used in the management of various cardiovascular conditions. The choice of agent depends largely on specific pharmacological effects of individual agents with respect to the condition. One of the most important factors affecting inotropic state is the level of calcium in the cytoplasm of the muscle cell ...