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 angina.

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.
  The following positive inotropes includes
  • Amrinone.
  • Digoxin (Cardoxin® or Lanoxin®).
  • Dobutamine.
  • Dopamine.
  • Enoximone.
  • Epinephrine (Adrenalin® or Auvi-Q®).
  • Levosimendan.
  • Milrinone.
  • Norepinephrine (Levophed® or Levarterenol®).
• 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.
  The following negative inotropes includes:
  • Amrinone.
  • Digoxin (Cardoxin® or Lanoxin®).
  • Dobutamine.
  • Dopamine.
  • Enoximone.
  • Epinephrine (Adrenalin® or Auvi-Q®).
  • Levosimendan.
  • Milrinone.
  • Norepinephrine (Levophed® or Levarterenol®).

Reasons for undergoing the procedure

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

Negative inotropes are commonly used by individuals not facing life-threatening situations. For example, they may take these medications regularly to help maintain normal blood pressure.

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

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

Negative inotropes medication are used to treat:

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

Procedure

Positive inotropes enhance the strength of your heart muscle contractions, ensuring efficient blood flow to vital organs. Healthcare providers typically initiate treatment with the smallest effective dose of inotropes for the shortest necessary duration. However, they may extend the use of these medications based on individual patient needs and medical conditions.

Positive inotropes are often administered alongside vasopressors. For example, if you are being treated for shock, your healthcare provider may initially use a vasopressor to constrict your blood vessels and raise your blood pressure. Later, they may introduce an inotropic agent to bolster your heartbeat’s strength and enhance cardiac function.

Negative inotropes help maintain blood pressure within a normal range and reduce occurrences of chest pain or abnormal heart rhythms.

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.