Role of nonglycosidic inotropic agents: indications, ethics, and limitations

Nonglycosidic inotropic agents have been used for short-term management of low output states and hypotension that complicates acute myocardial infarction for several years. Without adequate reperfusion of the ischemic myocardium, inotropic agents are seldom effective to produce sustained hemodynamic responses. Furthermore, potential exists for enhancement of ischemia and extension of myocardial necrosis. Thus, inotropic and vasopressors therapy should be regarded as temporary supportive treatment in patients with acute coronary syndrome and should be discontinued as soon as feasible. Parenteral sympathomimetic agents are used for management of exacerbations of chronic systolic heart failure. Although hemodynamics and occasionally clinical status improve such therapy is associated with increased mortality and potentially can hasten patient's demise.