Inotropes

Overview

Inotropes are medications designed to manage various heart conditions by either enhancing or reducing the force of heart muscle contractions. Positive inotropes strengthen contractions and are used to treat conditions such as cardiogenic shock and bradycardia. Conversely, negative inotropes weaken contractions to help manage conditions like hypertension and chest pain.

Types

There are two types of inotropes:

• Positive inotropes: Positive inotropes are beneficial when your heart is unable to supply enough blood to your body due to its weakened pumping ability. These medications enhance the strength of your heart muscle contractions, thereby increasing cardiac output to a normal level. This change allows your heart to pump out a greater amount of blood, ensuring adequate delivery of blood and oxygen to your organs, thereby supporting their proper function.

Positive inotropes include epinephrine, norepinephrine, dopamine, dobutamine, digoxin, amrinone, enoximone, levosimendan, and milrinone.

• Negative inotropes: Negative inotropes reduce the workload on the heart muscle by decreasing its forceful contractions. This is beneficial in conditions such as high blood pressure, chest pain, abnormal heart rhythms, or diseases like hypertrophic cardiomyopathy.

Negative inotropic agents include flecainide, verapamil, cibenzoline, clonidine, atenolol, disopyramide, sunitinib, and itraconazole.

Reasons for using inotropes

Positive inotropes are typically given to critically ill patients with congestive heart failure, often in an intensive care unit (ICU). These medications are administered intravenously through a large central vein. If you receive inotropic therapy, your healthcare provider will carefully monitor your heart rhythm, vital signs, and fluid levels. In some cases of end-stage heart failure, patients may continue to receive IV inotropes even after discharge, with home management under medical supervision.

Positive inotropes work by strengthening heart muscle contractions, ensuring efficient blood flow to vital organs. Treatment usually starts with the smallest effective dose for the shortest necessary time, but the duration may be adjusted based on individual needs and medical conditions.

Inotropes are often used in conjunction with vasopressors. For instance, if you are being treated for shock, your healthcare provider may first use a vasopressor to constrict blood vessels and increase blood pressure, and later introduce an inotropic agent to enhance the strength of your heartbeat and improve cardiac function.

Healthcare providers use positive inotropic medications to treat individuals with conditions such as:

• Cardiogenic shock.
• Septic shock.
• Heart failure.
• Postoperatively after open-heart surgery.
• Pulmonary hypertension.
• Bradycardia.
• Allergic reactions.
• Major surgery.
• Major trauma.

Negative inotropes are often used by individuals who are not in life-threatening situations. For instance, they might take these medications regularly to help manage blood pressure. Negative inotropes help keep blood pressure within a normal range and reduce the frequency of chest pain or abnormal heart rhythms.

Negative inotropes medication are used to treat:

• High blood pressure.
• Angina (chest pain).
• Arrhythmia.
• Hypertrophic obstructive cardiomyopathy.

Outcome

Positive inotropes increase cardiac output, which can be life-saving. Negative inotropes normalize blood pressure and alleviate symptoms like chest pain and heart rhythm issues.

Recovery after a hospital stay may require time. As your condition improves, your healthcare provider will gradually reduce the dosage of positive inotropes you receive. However, some individuals experience worsening symptoms when the provider attempts to discontinue inotropes. In these situations, ongoing administration of inotropes is necessary until a heart transplant or mechanical heart device becomes feasible. For those unable to recover, inotropic therapy may be provided at home as part of hospice care.

If prescribed negative inotropes, you may require long-term use to prevent heart issues and maintain cardiovascular health. Regular monitoring by your healthcare provider ensures the treatment’s effectiveness and safety.

After leaving the hospital, it’s crucial to contact your healthcare provider if symptoms recur or worsen. Promptly inform them of any adverse reactions to new medications you start taking. This communication helps ensure timely adjustments to your treatment plan and supports your recovery.

If not hospitalized, notify your healthcare provider if the medication you are using proves ineffective or causes adverse side effects.