Inotropic Agents

  • R. N. Sladen
Part of the Yearbook of Intensive Care and Emergency Medicine 1994 book series (YEARBOOK, volume 1994)


Inotropic agents may be classified according to their primary mechanism of action (Table 1), i. e. whether their action is dependent on or independent of cyclic adenosine monophosphate (cAMP) [1]. The most important inotropic agents used clinically are cAMP-dependent: β-receptor agonists (e. g. epinephrine) and phosphodiesterase inhibitors (e. g. amrinone), which will be discussed in this chapter. Forskolin is a direct activator of adenylyl cyclase and therefore independent of the β-receptor. Dibutyryl cAMP is a cAMP analogue which directly stimulates calcium ingress. Both these agents are investigational and useful in defining mechanisms of inotropic action. Digoxin, which inhibits the cellular sodium-potassium pump, and calcium, the “third messenger” in all muscle contraction, act independently of cAMP. However, their usefulness as IV inotropic agents is limited by their toxic effects. Alpha-receptor agonists (e. g. norepinephrine) may have important inotropic activity in congestive cardiac failure where there has been down-regulation of the β-receptors.


Cardiopulmonary Bypass Adenylyl Cyclase Renal Blood Flow Inotropic Agent Inotropic Activity 
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© Springer-Verlag Berlin Heidelberg 1994

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  • R. N. Sladen

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