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New and Old Inotropic Drugs: Controversies and Challenges

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Assessment of Ventricular Function

Part of the book series: Ettore Majorana International Science Series ((LIFESCI,volume 21))

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Summary

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.

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Author information

Authors and Affiliations

  1. Klinik Barmelweid, CH-5017, Barmelweid, Switzerland

    G. Cocco & P. Jerie

  2. Cardiological Ambulance, Solbadklinik, CH-4310, Rheinfelden, Switzerland

    G. Cocco & P. Jerie

Authors
  1. G. Cocco
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  2. P. Jerie
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Editors and Affiliations

  1. University of Palermo Medical Center, Palermo, Italy

    Angelo Raineri

  2. Texas Heart Institute, Houston, Texas, USA

    Robert D. Leachman

  3. The Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Jan J. Kellermann

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© 1985 Plenum Press, New York

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Cocco, G., Jerie, P. (1985). New and Old Inotropic Drugs: Controversies and Challenges. In: Raineri, A., Leachman, R.D., Kellermann, J.J. (eds) Assessment of Ventricular Function. Ettore Majorana International Science Series, vol 21. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-8003-0_26

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  • DOI: https://doi.org/10.1007/978-1-4684-8003-0_26

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4684-8005-4

  • Online ISBN: 978-1-4684-8003-0

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