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Inotropes and Heart : When to Use and When Not to Use 517

DRUG MECHANISM EFFECT ON MORTALITY
CONVENTIONAL INOTROPES:
ADRENERGIC AGENTS
Dopamine Dose-dependent D1, α1-, and β1-adrender- Increased
gic receptor agonist
Dobutamine β1- and β2-adrenergic receptor agonist Increased
Norepinephrine β1- and α1-adrenergic receptor agonist Increased
NON ADRENERGIC AGENTS
Phosphodiesterase inhibitor
Milrinone PDE inhibitor, raises SR calcium Increased
Enoximone PDE inhibitor Increased
Calcium sensitizing agent
Levosimendan Myofilament calcium sensitizer, PDE-3 Neutral
inhibitor
Digitalis
Digoxin Na-K pump inhibitor, raises SR calcium Neutral, increased mortality if
long-term therapy discontinued
NEWER EMERGING AGENTS
Omecamtiv mecarbil Potentiates the effects of myosin on Unknown
actin to prolong systole
Istaroxime Na-K pump inhibitor, PDE inhibitor Unknown
SERCA2a gene therapy Restoration of SERCA2a to improve calci- Unknown
um release and reuptake from the SR

Pic 1: Intracellular Signaling Cascades Within Cardiomyocytes Altered by Inotropes [1]

Cardio Diabetes Medicine