Intravenous positive inotropic therapy for acute decompensated heart failure

Intravenous positive inotropic agents play an important role in the short-term management of acute decompensated heart failure. The most commonly used positive inotropic agents are beta-adrenergic agonists and phosphodiesterase inhibitors. Positive inotropic effect of these drugs is primarily through increasing cAMP and calcium concentration in cardiac myocytes, in which circumstance increased intracellular calcium consentrations may lead to serious adverse events. Calcium-sensitizing agents, in contrast, exert positive inotropic action by increasing the sensitivity of the contractile apparatus to calcium. Theoretically, these agents do not present major limitations of cAMP-dependent agents because they increase myocardial contractility without increasing intracellular cAMP or calcium. Levosimendan is a new calcium-sensitizing agent used in the treatment of decompensated heart failure. In this paper, we reviewed the use of intravenous positive inotropic agents and levosimendan in the treatment of acute decompensated heart failure.