Inotrope

Types of muscle contractions

Agent that alters the force or energy of muscular contractions.

- Inotrope

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Adrenaline

Hormone and medication which is involved in regulating visceral functions .

The biosynthesis of adrenaline involves a series of enzymatic reactions.

A case has been made for the use of adrenaline infusion in place of the widely accepted treatment of inotropes for preterm infants with clinical cardiovascular compromise.

Theophylline

Phosphodiesterase inhibiting drug used in therapy for respiratory diseases such as chronic obstructive pulmonary disease and asthma under a variety of brand names.

Theophylline extended-release tablets in Japan

increasing heart muscle contractility and efficiency (positive inotrope)

Cardiogenic shock

Medical emergency resulting from inadequate blood flow due to the dysfunction of the ventricles of the heart.

Medications that improve the heart's ability to contract (positive inotropes) may help; however, it is unclear which is best and at present there is no convincing evidence supporting inotropic or vasodilating therapy to reduce mortality in hemodynamically unstable patients.

Angiotensin

Peptide hormone that causes vasoconstriction and an increase in blood pressure.

Crystal structure of reactive center loop cleaved angiotensinogen via x-ray diffraction
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Angiotensin II results in increased inotropy, chronotropy, catecholamine (norepinephrine) release, catecholamine sensitivity, aldosterone levels, vasopressin levels, and cardiac remodeling and vasoconstriction through AT1 receptors on peripheral vessels (conversely, AT2 receptors impair cardiac remodeling).

Myocardial contractility

Myocardial contractility represents the innate ability of the heart muscle (cardiac muscle or myocardium) to contract.

Contractility may be iatrogenically altered by the administration of inotropic agents.

Metoprolol

Selective β1 receptor blocker medication.

Skeletal formula of propranolol, the first clinically successful beta blocker

By working on the beta-1 receptor of the cardiac muscle cells, it yields both a chronotropic and inotropic effect.

Decompensation

Functional deterioration of a structure or system that had been previously working with the help of allostatic compensation.

Statue of Asclepius, the Greek god of medicine, holding the symbolic Rod of Asclepius with its coiled serpent

Short-term treatment of cardiac decompensation can be achieved through administration of dobutamine, resulting in an increase in heart contractility via an inotropic effect.

Calcium channel blocker

Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium through calcium channels.

General chemical structure of dihydropyridine calcium channel blockers (dipines)
Skeletal formula of verapamil
Structural formula of diltiazem
Lipid emulsion as used in CCB toxicity
Ethanol blocks voltage-gated calcium channel
A calcium channel embedded in a cell membrane.
Immunohistochemical analysis of L-type calcium channel Cav1.3 (CACNA1D) in human adrenal cortex: Marked immunoreactivity was detected in the zona glomerulosa. In the figure: ZG = zona glomerulosa, ZF = zona fasciculata, AC = adrenal capsule. Immunohistochemistry was performed according to published methods.

Reducing the force of contraction of the myocardium is known as the negative inotropic effect of calcium channel blockers.

Dobutamine

Medication used in the treatment of cardiogenic shock and severe heart failure.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.

Dobutamine is used to treat acute but potentially reversible heart failure, such as which occurs during cardiac surgery or in cases of septic or cardiogenic shock, on the basis of its positive inotropic action.

Heart failure

Set of manifestations caused by the failure of the heart's function as a pump supporting the blood flow through the body; its signs and symptoms result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood or its ejecting of it during each heart beat.

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
Signs and symptoms of severe heart failure
Severe peripheral pitting edema
Kerley B lines in acute cardiac decompensation. The short, horizontal lines can be found everywhere in the right lung.
Model of a normal heart (left); and a weakened heart, with over-stretched muscle and dilation of left ventricle (right); both during diastole
Chest radiograph of a lung with distinct Kerley B lines, as well as an enlarged heart (as shown by an increased cardiothoracic ratio, cephalization of pulmonary veins, and minor pleural effusion as seen for example in the right horizontal fissure. Yet, no obvious lung edema is seen. Overall, this indicates intermediate severity (stage II) heart failure.
Siderophages (one indicated by white arrow) and pulmonary congestion, indicating left congestive heart failure
Ultrasound showing severe systolic heart failure
Congestive heart failure with small bilateral effusions
Kerley B lines

Certain calcium channel blockers, such as diltiazem and verapamil, are known to decrease the force with which the heart ejects blood, thus are not recommended in people with heart failure with a reduced ejection fraction.