Skip to main content

Inotropes in the management of acute heart failure.

Publication ,  Journal Article
Petersen, JW; Felker, GM
Published in: Crit Care Med
January 2008

Impaired cardiac contractility is a fundamental component of the heart failure syndrome, initiating the cycle of vasoconstriction, neurohormonal and inflammatory activation, and adverse ventricular remodeling that leads to heart failure progression. Based on this core paradigm, drugs that increase cardiac contractility (positive inotropes) are theoretically appealing as a heart failure therapy, and such agents have been extensively investigated in both acute and chronic heart failure. Although these agents clearly improve cardiac output, their use in heart failure has consistently been associated with increased myocardial oxygen demand, cardiac arrhythmias, and mortality in a variety of clinical settings. Based on these data, the routine use of inotropes as heart failure therapy is not indicated in either the acute or chronic setting. Inotropes may be a necessary evil in a subset of acute heart failure patients, such as those with acute heart failure decompensation in the setting of clinically evident hypoperfusion or shock, or as a bridge to more definitive treatment, such as revascularization or cardiac transplantation. Currently available inotropes, such as dobutamine and milrinone, act (directly or indirectly) by increasing cyclic adenylate monophosphate and therefore intracellular calcium flux. Whether newer inotropes with differing mechanisms of action will realize the potential clinical benefits of inotropic therapy without the risk remains a subject of ongoing investigation.

Duke Scholars

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2008

Volume

36

Issue

1 Suppl

Start / End Page

S106 / S111

Location

United States

Related Subject Headings

  • Simendan
  • Pyridazines
  • Patient Selection
  • Hydrazones
  • Humans
  • Hemodynamics
  • Heart Failure
  • Emergency & Critical Care Medicine
  • Cardiotonic Agents
  • Cardiac Myosins
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Petersen, J. W., & Felker, G. M. (2008). Inotropes in the management of acute heart failure. Crit Care Med, 36(1 Suppl), S106–S111. https://doi.org/10.1097/01.CCM.0000296273.72952.39
Petersen, John W., and G Michael Felker. “Inotropes in the management of acute heart failure.Crit Care Med 36, no. 1 Suppl (January 2008): S106–11. https://doi.org/10.1097/01.CCM.0000296273.72952.39.
Petersen JW, Felker GM. Inotropes in the management of acute heart failure. Crit Care Med. 2008 Jan;36(1 Suppl):S106–11.
Petersen, John W., and G. Michael Felker. “Inotropes in the management of acute heart failure.Crit Care Med, vol. 36, no. 1 Suppl, Jan. 2008, pp. S106–11. Pubmed, doi:10.1097/01.CCM.0000296273.72952.39.
Petersen JW, Felker GM. Inotropes in the management of acute heart failure. Crit Care Med. 2008 Jan;36(1 Suppl):S106–S111.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

January 2008

Volume

36

Issue

1 Suppl

Start / End Page

S106 / S111

Location

United States

Related Subject Headings

  • Simendan
  • Pyridazines
  • Patient Selection
  • Hydrazones
  • Humans
  • Hemodynamics
  • Heart Failure
  • Emergency & Critical Care Medicine
  • Cardiotonic Agents
  • Cardiac Myosins