John Teerlink: Cardiac calcitropes (catecholamines, PDE3 inhibitors) increase contractility, ischemia, arrhythmias, mortality. We use them anyway because it's what we've got. #CCC50
OPTIME-CHF: Milrinone for CHF exacerbation when NOT requiring inotropes. No clinical benefit but trend for more MI/death and significant increase in arrhythmias and hypotension.
OptimaCC: epi vs norepi in cardiogenic shock in MI: no difference in change in cardiac index, but discontinued for harm in epi group (tachycardia and increase in refractory shock). So maybe use norepi?
VANISH: Early vaso vs norepi in kidney failure and sepsis. No difference in renal function.
Heart rate limiting inotropic therapies? Small studies show ivabradine selectively blocks hyperpolarization-activated cyclic nucleotide gated channel in SA node, inhibiting funny current. Selectively decreases heart rate, ONLY in sinus rhythms.
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