New and Old Inotropic Drugs: Controversies and Challenges

  • G. Cocco
  • P. Jerie
Part of the Ettore Majorana International Science Series book series (volume 21)


Many studies, using different parameters for contractility, have established that some inotropic reserve exists even in severly failing myocardium. Thus, various agents (such as digitalis, sympathomimetic drugs etc.) can augment the myocardial inotropic state in heart failure to various degrees. The aim of this paper is to describe available positive inotropic drugs, classified according to their mechanism of action. Drugs with established positive inotropic effect are described first. In addition, new agents with sufficiently high oral bioavailability and long duration of action are presented. Of increasing importance are drugs which combine a positive inotropic and a vasodilator effect (e.g., methylxanthines, some ß-agonists, amrinone etc.). Indeed, it appears that one of the most favorable effects of positive inotropic drugs is the simultaneous direct or reflex peripheral vasodilation. Lastly, it remains to be determined whether or not pronounced, sustained inotropic stimulation of the myocardium can produce a potentially deleterious imbalance in the myocardial energy supply-demand relationship, or whether the potential exists for arrhythmia induction by some of these agents. Based on these considerations, it seems likely that inotropic drugs alone will not represent the most favorable therapy for the severely failing heart.


Heart Failure Chronic Heart Failure Cardiac Glycoside Positive Inotropic Effect Isosorbide Dinitrate 
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Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • G. Cocco
    • 1
    • 2
  • P. Jerie
    • 1
    • 2
  1. 1.Klinik BarmelweidBarmelweidSwitzerland
  2. 2.Cardiological AmbulanceSolbadklinikRheinfeldenSwitzerland

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