Physical and pharmacological conditioning in chronic heart failure: a proposal for pulsed inotrope therapy

There is good evidence that physical deconditioning may be playing an important role in the changes secondary to chronic heart failure, and that it may contribute to exercise intolerance. Physical training can improve the symptoms and exercise performance of patients in stable chronic heart failure and the possibility is discussed that pharmacological therapy may be able to stimulate some of these benefits. A protocol for pulsed inotrope therapy is proposed which may produce pharmacological conditioning whilst avoiding drug tolerance and beta-receptor down-regulation and lessening the incidence of arrhythmias.