[Positive inotropic substances in therapy of heart failure: digitalis, catecholamines, phosphodiesterase inhibitors]

Abstract

The discussion about the importance of inotropic agents in the treatment of congestive heart failure is still open. A review of studies concerning the effects of digitalis, adrenoceptor stimulating or blocking agents, as well as phosphodiesterase inhibitors on hemodynamics and the physical state of heart failure patients is presented. Most authors agree that digitalis is indicated in patients with impaired left ventricular function and supraventricular arrhythmias, as well as in patients with heart failure who remain symptomatic during treatment with diuretics and vasodilators. While adrenoceptor stimulation with catecholamines is widely accepted in patients with acute and severe heart failure, beta-receptor blockers seem to have beneficial effects on some patients with mild to moderate congestive heart failure.