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Cardiotonic agents, also known as cardiac inotropes or stimulants, have a positive impact on the myocardium (muscular layer of the heart) by enhancing its contractility. . Unlike general inotropes, these agents exhibit a higher level of specificity as they selectively target the myocar
Positive inotropes are used to support cardiac function in conditions such as decompensated congestive heart failure, cardiogenic shock, septic shock, myocardial infarction, cardiomyopathy, etc. [10] Examples of positive inotropic agents include: [citation needed] Digoxin; Berberine; Calcium; Calcium sensitisers Levosimendan [11] Catecholamines ...
The effects of amrinone vary widely with species and experimental condition; therefore, its inotropic effects are variable. [3] A loss in sensitivity to phosphodiesterase 3 inhibitors, including amrinone, has been observed in end stage heart failure in humans; other treatment options may be more useful for improvement in these stages. [3]
PKA also phosphorylates components on myofilaments allowing actin and myosin to interact more easily and thus increasing contractility and the inotropic state of the heart. Milrinone allows stimulation of cardiac function independently of β-adrenergic receptors which appear to be down-regulated in those with heart failure. [13]
PDE3 inhibitors are indicated as inotropics for the therapy of acute heart failure if catecholamines are ineffective. [2] Well controlled studies have shown that these drugs generally increase mortality , [ 3 ] when used for the therapy of acute heart failure, so they have to be applied under close observation.
It primarily works by direct stimulation of β 1 receptors, which increases the strength of the heart's contractions, leading to a positive inotropic effect. Generally it has little effect on a person's heart rate. [2] Dobutamine was approved for medical use in the United States in 1978. [2] It is available as a generic medication. [5]
Levosimendan is a calcium sensitizer — it increases the sensitivity of the heart to calcium, thus increasing cardiac contractility without a rise in intracellular calcium. Levosimendan exerts its positive inotropic effect by increasing calcium sensitivity of myocytes by binding to cardiac troponin C in a calcium
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.
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