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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 ]
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.
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).
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]
Istaroxime is a positive inotropic agent [2] that mediates its action through inhibition of sodium/potassium adenosine triphosphatase (Na+/K+ ATPase). [7] Na+/K+ ATPase inhibition increases intracellular sodium levels, which reverses the driving force of the sodium/calcium exchanger, inhibiting calcium extrusion and possibly facilitating calcium entry., [5] [8]
Epinephrine (adrenaline). Activation of β 1 receptors induces positive inotropic, chronotropic output of the cardiac muscle, leading to increased heart rate and blood pressure, secretion of ghrelin from the stomach, and renin release from the kidneys.
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]
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