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[Positive inotropic substances--therapeutic perspectives].

E Erdmann¹, M Böhm

¹Medizinische Klinik I, Universität München, Klinikum Grosshadern.

Zeitschrift Fur Kardiologie

|January 1, 1991

Summary

In severe chronic heart failure, positive inotropic drugs lose efficacy due to biochemical changes. Cardiac glycosides remain effective, while phosphodiesterase III inhibitors show unfavorable outcomes.

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Area of Science:

Cardiology
Biochemistry

Context:

Severe chronic heart failure involves downregulated myocardial beta-adrenoceptors and augmented inhibitory G-proteins.
These changes impair the efficacy of drugs requiring cyclic adenosine monophosphate (cAMP) for contractile effects.

Purpose:

To evaluate the efficacy and prognosis of different positive inotropic drugs in severe chronic heart failure.
To determine appropriate therapeutic strategies for advanced heart failure.

Summary:

Cardiac glycosides maintain effectiveness in heart failure without tolerance, provided sufficient contractile myocardium remains.
Controlled studies indicate phosphodiesterase III inhibitors (milrinone, enoximone) are associated with unfavorable prognosis in these patients.
Therapy for advanced chronic heart failure should combine diuretics, digitalis, and angiotensin-converting enzyme (ACE) inhibitors.

Impact:

Phosphodiesterase III inhibitors are not indicated for chronic heart failure treatment.
Current evidence supports a combination therapy approach for managing severe chronic heart failure.

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