Potential deleterious effects of inotropic agents in the therapy of chronic heart failure.

Inotropic stimulation of the failing heart, although a logical adjunct in short-term efforts to maintain circulatory function in patients with heart failure, has several potentially deleterious effects that may limit its usefulness in long-term therapy for patients with congestive heart failure. These deleterious effects include cell damage caused by an increased rate of energy expenditure, exacerbation of relaxation abnormalities, and potential arrhythmogenic side effects that may result from increased cytosolic Ca++ and cyclic AMP concentrations in the inotropically stimulated myocardium. Recognition of these possible side effects should allow the therapeutic benefits of this approach to long-term therapy to be evaluated in carefully controlled clinical trials.