Observed effects of crude Hawthorn extract and cardiotonic drugs on cardiomyocytes Start-up Arrhythmia Drug name Effect on rate observed promotion Hawthorn extract (tablet Decrease Yes No batch 1) (30-300 18 of 22 1 of 22 [micro]g/ml) Epinephrine (5-50 [micro]M) Increase Yes Yes 14 of 17 15 of 17 Propranolol (10-50 [micro]M) Decrease No Yes 0 of 15 12 of 15 Ouabain (20-500 [micro]M) Increase Inconclusive Inconclusive 6 of 21 12 of 21 Milrinone
(10-20 [micro]M) Increase Inconclusive Inconclusive PBS (vehicle) No effect No No 0 of 8 1 of 12 Effects on cardiomyocyte contraction rate are summarized from the results shown in Fig.
Inotropes have been shown to be associated with a worse outcome, but milrinone
, which is both an inotrope and a vasodilator, may be associated with some improvement in outcome.
Patients treated with the vasodilator nitroglycerin or the natriuretic peptide nesiritide had better survival rates and shorter hospital stays than did those treated with the positive inotropic agents dobutamine and milrinone
, the researchers said.
Cardiovascular: HR DDD paced, on 5 mcg/kg/min of dopamine and 0.25 mcg/kg/min of milrinone
, pulses 1+ throughout, CFT 2-3 seconds, color pink but pale.
He is clinging to life on the drug milrinone
, which relaxes the muscles in blood vessels to help them widen.
Because of clinical signs of pulmonary congestion, diuretic and inotropic therapies (milrinone
and dobutamine) were initiated, with some improvement in the hemodynamic parameters.
is a PDE3 inhibitor that leads to increased availability of cAMP, with resultant positive inotropic effects, peripheral vasodilatation, left ventricular afterload reduction and increased myocardial contractility.
Thereafter, if the cardiac index ( CI ) was <2.5 L?min[sup]−1?m[sup]−2 , dobutamine, milrinone
or epinephrine was administered as an intravenous infusion to achieve a CI >2.5 L?min[sup]−1?m[sup]−2 .
The beta adrenergic drug therapy should be combined with a Phosphodiesterase-3 inhibitor such as Milrinone
(bolus of 50[micro]g/kg over 10 minutes and continuous infusion of 0.5-0.75[micro]g/kg/min).
, a phosphodiesterase inhibitor, can also be administered as it helps improve the diastolic function of the heart and, hence, improve ventricular relaxation and filling times.
Phosphodiesterase inhibitors (amrinone and milrinone
) are used to increase heart contractility in heart failure, as they stop the breakdown of cAMP and thus increasing their levels7.