THE ROLE OF POSITIVE INOTROPIC AGENTS IN SEVERE CONGESTIVE-HEART-FAILURE

Inotropic agents improve the hemodynamic parameters and lessen the sym ptoms of patients with severe congestive heart failure (CHF), but ther e is no evidence that they decrease CHF-related mortality. Digoxin is the safest and most efficacious of these agents and usually is the fir st one employed in severe CHF, although in moderate doses only, Short- term, intermittent infusions of dobutamine or milrinone are indicated in cases refractory to digoxin. Low doses of dopamine, particularly as combination therapy, offer benefits in some cases of severe CHF. The potential role in CHF for such inotropes as norepinephrine, epinephrin e, isoproterenol, and amrinone is less clear, Novel approaches, such a s use of the oral phosphodiesterase inhibitors vesnarinone and pimoben dan or the thyroid hormone levothyroxine, offer promise but remain in investigational stages.