Cardiotonic: review of drugs, efficacy and feedback

Cardiotonic drugs are drugs that enhance the activity of the heart muscle, its contractility and are used in the therapy of heart failure. The group includes a significant number of drugs that have different active substances in the composition and a different mechanism of action. Cardiotonics are used to treat acute and chronic heart failure.

Cardiotonic: classification

The overall effect of all drugs in the group is based on the ability to increase the strength of myocardial contractions, resulting in increased cardiac output and stroke volume. Cardiotonic agents reduce the diastolic volume, pulmonary and systemic pressure in the veins, as well as the pressure when filling the ventricles.

1. Cardiac glycosides - "Strofantin", "Korglikon", "Digoxin".
2. Adrenergic drugs - "Isadrin", "Dobutamine", "Dopamine".
3. Non-adrenergic synthetic preparations - "Amrinon", "Milrinon".

The choice of drugs used is related to the severity of the patient's condition and the form of the course of the disease.

Cardiac glycosides

The group is represented by means of plant or synthetic origin. Preparations based on plant substances are obtained from digitalis, gorizveta, lily of the spring, oleander, strophete, etc.

The duration of the therapeutic effect, the effect of accumulation in the body and the neurotoxicity of the drugs are completely dependent on their ability to form complexes with plasma proteins. The stronger this connection, the higher the efficiency of glycoside. Cardiotonic drugs in this group have an effect based on the following mechanisms:

• There is a shortening of the systole with its simultaneous enhancement;
• The rest period of the heart muscle is lengthened;
• Decreases the heart rate;
• The ability of the myocardium muscle to excite increases;
• When an overdose of drugs develops ventricular arrhythmia.

"Digoxin"

The drug is synthesized from the leaves of digitalis. Refers to long-acting glycosides, which do not cause serious side effects. It is used for the complex treatment of chronic heart failure and tachysystolic arrhythmia.

Produced in the form of tablets and injection solution. The dose should be selected carefully, for each patient individually. In the case of using other cardiac glycosides, the dosage is reduced before digoxin.

Strofantin

It is a short-acting cardiac glycoside, used in the case of an acute form of insufficiency. "Strophantine" is not peculiar to accumulate in the body. The drug increases the contractile function of the myocardium and increases the minute volume of blood. In parallel, there is a reduction in the size of the heart muscle and a decrease in its need for oxygen.

It is used intravenously, intramuscularly, in some cases - inside. Taking large amounts can lead to an overdose. The use with other drugs changes the effectiveness of the action of glycoside:

• With barbiturates the effect is reduced;
• With "Reserpine", sympathomimetics and antidepressants can cause the development of cardiac arrhythmia;
• Reception with tetracyclines, "Levomycetin", "Amiodarone" and "Captopril" intensifies cardiotonic action;
• Magnesium sulfate promotes the development of cardiac atrioventricular blockade.

Adrenergic drugs

Non-glycosidic cardiotonic agents with a short-term effect. The group is used in the acute course of heart failure to maintain important body functions.

"Isadrin" is a stimulator of adrenoreceptors of blood vessels, bronchi and heart. The drug has an antihypertensive effect, increases the contractility of the heart muscle. Used in cardiosurgery with a sharp decrease in contractility during surgery, as well as with cardiogenic shock. The doctors' comments warn: the incorrect use or excess of the dosage can cause fibrillation of the ventricles of the heart.

"Dobutamine" is a cardiotonic agent of a non-glycosidic structure, which has a stimulating effect on the heart muscle, as well as normalizing coronary blood flow. The risk of developing arrhythmias when using this remedy is low enough, since Dobutamine has practically no effect on cardiac automatism.

It is prescribed with rapid need to strengthen the contractility of the myocardium. In some cases, it may cause the development of side effects:

• nausea;
• headache;
• Hypertension;
• Increased heart rate;
• Pain behind the sternum.

Dopamine is a catecholamine that stimulates adrenoreceptors. The drug raises blood pressure, increases coronary blood flow. It is prescribed for acute myocardial insufficiency, shock. Caution should be used for myocardial infarction, pregnancy, thyroid diseases, arrhythmias.

Nonadrenergic synthetic cardiotonics

These are cardiotonic agents used in the case of acute coronary insufficiency . The drugs act on the contractility of the heart muscle, strengthening it. May provoke the development of arrhythmias and lowering blood pressure, impaired kidney function.

Cardiotonic medicines of this group can not be used for heart diseases, as well as cardiomyopathy, cardiac rhythm disturbance, aortic aneurysm, kidney failure, heart attack and during child bearing.

Amrinon is used exclusively in intensive care units, so that the patient is constantly under the control of special devices that signal his condition. In addition to increasing heart rate, the drug dilates blood vessels, increases blood flow during systole, and reduces pulmonary pressure.

Issued in the form of a solution. For intravenous administration, it is diluted exclusively in physiological saline solution of sodium chloride. Do not mix with other medicines. With the introduction of a possible sharp reduction in pressure, increased heart rate, arrhythmia, the appearance of headache, gastrointestinal disorders.

"Milrinon" is more active than the first representative of the group, and according to reviews is better tolerated by patients. Contraindicated use of the drug during pregnancy and the development of myocardial infarction. Refers to the drugs group A. The need for the use of the drug is determined exclusively by the doctor.

Conclusion

Cardiotonic drugs have proven the effectiveness of the application several generations ago. Reviews suggest that the drugs of this group help to cope with heart failure. However, the use of such medications in the form of self-medication is strictly contraindicated because of the development of possible complications, side effects or overdose. The choice of a preparation, as well as a dose of reception, is defined by the cardiologist in each clinical case individually.