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Which Inotrope Should Be Used?

When patients taking beta-blockers decompensate (suffer an
acute heart failure episode), they may need treatment with
a positive inotrope (see www.chfpatients.com/inotropes.htm).
	Dobutamine may not cause much of an increase in
cardiac output during full-dose beta-blocker treatment and
may increase blood pressure. In contrast, phosphodiesterase
inhibitors (PDEIs) such as milrinone still work in patients
on full-dose beta-blocker therapy because the site of action
of PDEIs is beyond the beta receptor. Also, beta-blockers
reverse some of the desensitization that prevents PDEIs from
continuing to work.
	Decompensated heart failure patients on long-term
beta-blocker therapy should be treated with a type III-specific
PDEI, not dobutamine.

Title: Inotropes and beta-blockers: is there a need for new guidelines?
Authors: Bristow MR, Shakar SF, Linseman JV, Lowes BD.
Source: J Card Fail 2001 Jun;7(2 Suppl 1):8-12.
PMID: 11605160.