Inotropa läkemedel inom kardiologi

Intropa droger vid akut hjärtsvikt

I.v.-infusion av inotropa läkemedel (Dobutamine, Dopamin, Levosimendan, Phosphodiesterase-III-inhibitorer (t.e.x Milrinon/Corotrop) “may be considered” (ESC IIbC) hos patienter med akut hjärtsvikt som är hypotensiva (systolisk <90mmHg) och visar symptom på perifer hypoperfusion trots adekvat fyllnads-status (det vill säga som inte har vätskebrist), med målet att förbättra cardiac output och perifer perfusion/ändorganfunktion. Notera att flera inotropa läkemedel även har vasodilatativa effekter (det vill säga minskar blodtrycket) och därför kräver tillägg av en vasopressor (oftast noradrenalin). Inotropa droger skall enligt ESC, av säkerhetskäl, inte användas hos patienter som inte är hypotensiva och inte visar tecken på hypoperfusion (ESC IIIC).1 234 5

(sidan planeras för uppdatering)

Dosering inotropa droger

enligt ESC: 6

dosering inotropa droger
ESC guideline hjärtsvikt 2016

Se även sida Akut hjärtsvikt/inotropa läkemedel

Litteratur

Treatments targeting inotropy (EHJ 2019)2

Why has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials (Eur J heart fail 2019)3

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 7

Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine (Eur J heart fail 2015) 8

Se även

Kardiogen chock- differentialdiagnostik och behandling
Akut hjärtsvikt – initial handläggning och vidare utredning
Noradrenalin

Last Updated on November 7, 2021 by Christian Dworeck

Christian Dworeck
Latest posts by Christian Dworeck (see all)
Referenser
  1. Avsnitt 11.3.5: McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Aug 27:ehab368. doi: 10.1093/eurheartj/ehab368. Epub ahead of print. PMID: 34447992.[↩]
  2. Maack C, Eschenhagen T, Hamdani N, Heinzel FR, Lyon AR, Manstein DJ, Metzger J, Papp Z, Tocchetti CG, Yilmaz MB, Anker SD, Balligand JL, Bauersachs J, Brutsaert D, Carrier L, Chlopicki S, Cleland JG, de Boer RA, Dietl A, Fischmeister R, Harjola VP, Heymans S, Hilfiker-Kleiner D, Holzmeister J, de Keulenaer G, Limongelli G, Linke WA, Lund LH, Masip J, Metra M, Mueller C, Pieske B, Ponikowski P, Ristić A, Ruschitzka F, Seferović PM, Skouri H, Zimmermann WH, Mebazaa A. Treatments targeting inotropy. Eur Heart J. 2019 Nov 21;40(44):3626-3644. doi: 10.1093/eurheartj/ehy600. PMID: 30295807; PMCID: PMC7963133.[↩][↩]
  3. Ahmad T, Miller PE, McCullough M, Desai NR, Riello R, Psotka M, Böhm M, Allen LA, Teerlink JR, Rosano GMC, Lindenfeld J. Why has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials. Eur J Heart Fail. 2019 Sep;21(9):1064-1078. doi: 10.1002/ejhf.1557. Epub 2019 Aug 13. PMID: 31407860; PMCID: PMC6774302.[↩][↩]
  4. Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, Ristic AD, Lambrinou E, Masip J, Riley JP, McDonagh T, Mueller C, deFilippi C, Harjola VP, Thiele H, Piepoli MF, Metra M, Maggioni A, McMurray J, Dickstein K, Damman K, Seferovic PM, Ruschitzka F, Leite-Moreira AF, Bellou A, Anker SD, Filippatos G. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015 Jun;17(6):544-58. doi: 10.1002/ejhf.289. Epub 2015 May 21. PMID: 25999021.[↩]
  5. Mebazaa A, Motiejunaite J, Gayat E, Crespo-Leiro MG, Lund LH, Maggioni AP, Chioncel O, Akiyama E, Harjola VP, Seferovic P, Laroche C, Julve MS, Roig E, Ruschitzka F, Filippatos G; ESC Heart Failure Long-Term Registry Investigators. Long-term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long-Term Registry. Eur J Heart Fail. 2018 Feb;20(2):332-341. doi: 10.1002/ejhf.991. Epub 2017 Oct 8. PMID: 28990358.[↩]
  6. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128. Epub 2016 May 20. Erratum in: Eur Heart J. 2016 Dec 30;: PMID: 27206819.[↩]
  7. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Aug 27:ehab368. doi: 10.1093/eurheartj/ehab368. Epub ahead of print. PMID: 34447992.[↩]
  8. Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, Ristic AD, Lambrinou E, Masip J, Riley JP, McDonagh T, Mueller C, deFilippi C, Harjola VP, Thiele H, Piepoli MF, Metra M, Maggioni A, McMurray J, Dickstein K, Damman K, Seferovic PM, Ruschitzka F, Leite-Moreira AF, Bellou A, Anker SD, Filippatos G. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015 Jun;17(6):544-58. doi: 10.1002/ejhf.289. Epub 2015 May 21. PMID: 25999021.<[↩]

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