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Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
Inotropes (Table 9.2) improve hemodynamics and include dobutamine, milrinone, and dopamine. Despite favorable effects on cardiac output and filling pressures, inotropes are associated with ischemia from higher myocardial consumption, arrhythmias, and higher mortality—though these patients tend to be very ill.18 The OPTIME-CHF trial demonstrated higher in-hospital and 60-day mortality in patients with ADHF on milrinone compared to placebo. This group had increased incidence of atrial arrhythmias and hypotension, requiring intervention.19 This association with mortality is noted in the guidelines, as long-term continuous or intermittent use of IV inotropes for reasons other than palliation is harmful. Inotropes are indicated as a temporizing measure in cardiogenic shock or as a bridge to MCS or transplant.3 Thus, inotropes should be utilized judiciously in patients with systolic dysfunction and low cardiac index with evidence of hypoperfusion and should be discontinued when clinically indicated.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Cardiac glycosides cause inotropic effects on the heart and antiarrhythmic effects. Various digitalis preparations cross the placenta readily, resulting in fetal levels 50–80 percent of maternal levels (Chan et al., 1978; Rogers et al., 1972).
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Inotropic substances are those that alter myocardial contractility. A positive inotrope increases contractility, thereby increasing stroke volume and cardiac output, and a negative inotrope decreases contractility. Many inotropic agents also have chronotropic properties (affecting heart rate) and vasoactive properties and therefore can be somewhat complex to manage. For a summary of inotropic agents and their action, please see Table 6.11.
Clinical management in the takotsubo syndrome
Published in Expert Review of Cardiovascular Therapy, 2019
Sandeep Jha, Rickard Zeijlon, Aaron Shekka Espinosa, Jessica Alkhoury, Jonatan Oras, Elmir Omerovic, Björn Redfors
Arrhythmias occur in approximately 20% of patients with TS [32,63]. Electrolyte abnormalities increase the risk of arrhythmias and should be corrected promptly [23]. Atrial fibrillation is the most common arrhythmia in patients with TS [32,63]. Although atrial fibrillation is well tolerated by most patients with TS, it may reduce cardiac output and can lead to acute heart failure. For TS patients with atrial fibrillation who become hemodynamically unstable prompt cardioversion should be considered. For patients who are hemodynamically stable or in whom cardioversion is contra-indicated rate control is an option. However, negative inotropic drugs must be administered with caution to avoid exacerbation of cardiac dysfunction. Digoxin is an alternative for rate control in subjects with TS who develop atrial fibrillation with a rapid ventricular rate, but should be avoided in patients with LVOTO. Anti-arrhythmic drugs can also be used, but because TS is associated with a risk of ventricular arrhythmias the QTc interval must be carefully monitored, and QTc-prolonging medications should be avoided in the acute phase of TS [32].
Pharmacological and non-pharmacological treatment of obstructive hypertrophic cardiomyopathy
Published in Expert Review of Cardiovascular Therapy, 2018
Luis F. Hidalgo, Srihari S. Naidu, Wilbert S. Aronow
Pharmacological treatment of symptomatic obstructive hypertrophic cardiomyopathy is based on negative inotropes: Beta blockers and Non-dihydropyridine calcium channel blockers as first line medications and Disopyramide as a second line.Septal reduction therapy has become an effective approach to the patient with refractory symptoms to medical management, with studies showing improved functional status and symptoms in the vast majority of patients.There is no randomized clinical trial comparing septal myectomy and alcohol septal ablation, and current comparisons are made through observational studies and metanalysis. Such analyses have largely showed similar sustained symptom improvement, with a somewhat higher but still low rate of pacemaker placement after alcohol septal ablation.Current data suggest that both procedures have comparable low mortality in the long term, out to 8–10 years at least, and the main difference is seen on residual pressure gradient and need for reintervention, favoring surgical myectomy.Non pharmacological decisions, and choice of septal reduction therapy, should be made by a multidisciplinary team that ideally includes .an interventional cardiologist, imaging cardiologist and a cardiothoracic surgeon, at a minimum.
Myocardial bridge and beta blockers: effect on left ventricular strain parameters
Published in Acta Cardiologica, 2023
Patients with symptomatic MB require treatment that generally involves beta-blockers, non-dihydropyridine calcium channel blockers, and antiplatelet medication [20]. In instances where an association with myocardial ischaemia is discovered, a number of treatment approaches are available. The most commonly prescribed drugs are beta-blockers, which exert a negative inotropic and chronotropic impact. Zhang et al. evaluated the effect of Esmolol on coronary hemodynamics and reported that it could alleviate intramural coronary artery compression and raise CFR (coronary flow reserve) to a normal level [21]. Half of the patients in our study were using beta-blockers, and their heart rate was found to be significantly lower due to its negative chronotropic effect.