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When used at lower doses of up to 2.5 µg/kg/min, its primary net effect is vasodilation of the splanchnic, coronary and renal vasculature. 6,7ĭopamine is an endogenous catecholamine that exerts its dose-dependent effects on the cardiovascular system via its interaction with four different receptors: dopaminergic type 1 and type 2 and adrenergic alpha-1 and beta-1. Careful selection of the most appropriate inotrope for each individual patient is of utmost importance ( Table 1).Ĭurrently available inotropic agents for the management of patients with AHF can fall into three categories, based on their mechanism of action: dopamine, dobutamine, norepinephrine and epinephrine that act as beta-agonists milrinone, a phosphodiesterase (PDE) type 3 inhibitor and levosimendan, a calcium sensitiser ( Table 2). 1 However, they remain useful as short-term regimens for patients who present with AHF and evidence of hypoperfusion and impaired cardiac contractility. As a result, their use is not recommended as routine practice for all patients with HF. 5 However, the use of inotropes does have some adverse effects, including arrhythmogenesis and myocardial ischaemia, contributing to an unfavourable impact on long-term survival. They are most commonly used in hospital settings for patients with peripheral organ hypoperfusion and severely diminished cardiac output. 3 They also have chronotropic and peripheral vascular effects that accompany their positive inotropic effect. 2–4 Inotropes have been used in the management of patients with AHF for decades, especially for patients with systolic dysfunction – heart failure with reduced ejection fraction – due to their enhancing effect on cardiac contractility. 1 It is a life-threatening condition, with in-hospital mortality ranging from 22% to 37% in severe cases of cardiogenic shock. Novel inotropes that use alternative intracellular pathways are under investigation, in an effort to minimise the drawbacks that conventional inotropes exhibit.Īcute heart failure (AHF) is defined as the sudden presentation or sudden aggravation of signs and symptoms of heart failure, often requiring hospitalisation.
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However, due to the well-documented potential for adverse events and their association with increased long-term mortality, physicians should be aware of the indications and dosing strategies suitable for different types of patients. The currently available inotropic agents in clinical practice fall into three main categories: beta-agonists, phosphodiesterase III inhibitors and calcium sensitisers. They can be used for longer periods to support patients as a bridge to a more definite treatment, such as transplant of left ventricular assist devices, or as part of a palliative care regimen. They are usually administered for a short period during the initial management of AHF until haemodynamic stabilisation and restoration of peripheral perfusion occur. Inotropes are pharmacological agents that are indicated for the treatment of patients presenting with acute heart failure (AHF) with concomitant hypoperfusion due to decreased cardiac output.