Inotropic and Vasoactive Agents in the Cardiac Intensive Care Unit

Inotropes and vasopressors

“…At doses 0.5-0.2 μg/kg/min dopamine acts predominantly on dopaminergic (DA1) receptors and causes vasodilation of renal and mesenteric vasculature (6). It increases glomerular filtration rate and sodium excretion (17). With infusion rates of 2-10 μg/kg/min, dopamine stimulates β1 receptors, which leads to increased myocardial contractility and increased cardiac output.…”

“…When used in patients with acute decompensated heart failure, exacerbation of pulmonary edema can occur due to increased venous tone and pulmonary arterial pressure. In those cases venodilating agents may be added (17). It can also be useful to add dobutamine to augment the level of positive inotropic support (17).…”

“…Representative of this group of drugs is levosimendan.Levosimendan has a triple mechanism of action (16). It binds to troponin C which causes conformational changes leading to increased affinity of actin to myosin (17). Since it does not increase calcium levels, it does not impair diastolic function (4).…”

“…Results of recent studies have called routine use of dopamine in those patients into question (20)(21)(22), and new guidelines suggest that low-dose dopamine should not be used as a renal protection strategy (23). Dopamine is frequently combined with other inotropic or vasodilator agents (17). In patients with cardiogenic shock higher doses of dopamine are used to increase systemic vascular resistance.…”

“…In those cases venodilating agents may be added (17). It can also be useful to add dobutamine to augment the level of positive inotropic support (17). When used in treatment of patients with septic shock, dopamine can adversely affect splanchnic perfusion, and can also lead to splanchnic shunting, impairment of gastric mucosal oxygenation and increased risk of gastrointestinal bleeding (24).…”