Inotropic therapy for the failing myocardium

Clinical Cardiology
J B Shipley, M L Hess

Abstract

Congestive heart failure (CHF) is a common clinical entity with diverse causes. Patients may present with acute decompensation or have a more indolent course, with diminishing exercise tolerance and increasing dyspnea. The management of this clinical entity traditionally has focused on restricting fluid intake, decreasing dietary sodium, decreasing afterload with vasodilatory agents, and supporting the failing myocardium with agents which produce a positive inotropic response. In the acutely decompensated patient, short-term therapy with positive inotropics is clearly beneficial. The role of long-term inotropic therapy for chronic CHF remains less clear. A number of clinical trials have recently evaluated the effects of long-term therapy on morbidity and mortality, with disappointing results. For a number of the newer, nonglycocide oral positive inotropics, at doses of drug which produce measurable hemodynamic improvement, increased mortality in treatment groups has been unacceptably high. Ironically, patients with worse left ventricular dysfunction show the most clinical improvement, but have the highest increased mortality. However, as with digoxin, there is some evidence that employing lower doses of drug that do not produce...Continue Reading

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Citations

Jan 29, 2000·The Journal of Thoracic and Cardiovascular Surgery·C A WalkerF G Spinale
Nov 26, 1999·Journal of Cardiovascular Electrophysiology·P N SchauerteR Lazzara
May 23, 1998·Annual Review of Pharmacology and Toxicology·D K Rohrer, B K Kobilka
Apr 1, 2000·European Journal of Heart Failure·C OpasichL Tavazzi
Jan 28, 2015·Basic & Clinical Pharmacology & Toxicology·Xiuying TangYingfeng Liu
Oct 3, 2002·Nature Reviews. Drug Discovery·Richard A Bond
May 12, 1998·The American Journal of Physiology·D K RohrerD Bernstein

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