[Rational use of catecholamines and inotropes].
Acute heart failure syndromes (AHFS) are a growing health problem in Western Countries. Standard treatment includes vasodilators and diuretics, however, the subgroup of patients with AHFS and low cardiac output state represents a special therapeutic challenge that is complicated by high in-hospital and post-discharge mortality and by requiring additional i. v. inotropic support. The current inotropes in use are adrenoreceptor agonists (dopamine, dobutamine, norepinephrine, epinephrine), phosphodiesterase III inhibitors (milrinone, enoximone), and Ca2+ sensitizers (levosimendane). While most inotropes yield short-term haemodynamic improvements, they are associated with increased myocardial oxygen consumption, (supra-) ventricular arrhythmias and possibly increased post-discharge mortality. This review highlights current inotropes used in the treatment of AHFS and introduces new drug developments including myosin activators and Na+/K+ ATPase inhibitors.
Hewing
B
B
Universitätsmedizin Berlin, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie und Angiologie, Charité Campus Mitte, Berlin.
Stangl
K
K
D000208:Acute Disease; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002395:Catecholamines / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D002395:Catecholamines