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==Positive inotropic agents== {{main|Cardiotonic agent}} By increasing the concentration of intracellular [[calcium]] or increasing the sensitivity of receptor proteins to calcium, positive inotropic agents can increase [[myocardial contractility]].<ref>{{cite encyclopedia | vauthors = Gordon S, Saunders A |encyclopedia=The Merck Veterinary Manual |title=Positive Inotropes |url=http://www.merckvetmanual.com/mvm/pharmacology/systemic_pharmacotherapeutics_of_the_cardiovascular_system/positive_inotropes.html |date=November 2015 |access-date=2016-11-28 }}</ref> Concentrations of intracellular calcium can be increased by increasing influx into the cell or stimulating release from the sarcoplasmic reticulum.<ref>{{cite journal |title=Use of inotropes in critical care |journal=Clinical Pharmacist | date = January 2010 | vauthors = Berry W, McKenzie C |volume=2 |page=395 |url=http://www.pharmaceutical-journal.com/learning/learning-article/use-of-inotropes-in-critical-care/11049283.article |access-date=2016-11-28 }}</ref> Once in the cell, calcium can pass through one of two channels: the [[L-type calcium channel]] (long-lasting) and the [[T-type calcium channel]] (transient). These channels respond to voltage changes across the membrane differently: L-type channels respond to higher membrane potentials, open more slowly, and remain open longer than T-type channels. Because of these properties, L-type channels are important in sustaining an [[action potential]], while T-type channels are important in initiating them.<ref>{{cite book | vauthors = Sherwood L <!-- | author-link = Lauralee Sherwood --> |title=Human Physiology, From Cells to Systems |edition=7th |year=2008 |publisher=Cengage Learning |isbn=9780495391845 }}</ref> By increasing intracellular calcium, via the action of the L-type channels, the action potential can be sustained for longer and therefore, contractility increases. Positive inotropes are used to support cardiac function in conditions such as [[Decompensation|decompensated]] [[congestive heart failure]], [[cardiogenic shock]], [[septic shock]], [[myocardial infarction]], [[cardiomyopathy]], etc.<ref>{{cite journal | vauthors = Oba Y, Lone NA | title = Mortality benefit of vasopressor and inotropic agents in septic shock: a Bayesian network meta-analysis of randomized controlled trials | journal = Journal of Critical Care | volume = 29 | issue = 5 | pages = 706โ710 | date = October 2014 | pmid = 24857641 | doi = 10.1016/j.jcrc.2014.04.011 }}</ref> Examples of positive inotropic agents include:{{cn|date=January 2019}} * [[Digoxin]] * [[Berberine]] *[[Calcium]] *Calcium sensitisers **[[Levosimendan]]<ref>{{cite journal | vauthors = Hu Y, Wei Z, Zhang C, Lu C, Zeng Z | title = The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis | journal = Scientific Reports | volume = 11 | issue = 1 | pages = 24097 | date = December 2021 | pmid = 34916560 | pmc = 8677770 | doi = 10.1038/s41598-021-03317-5 | bibcode = 2021NatSR..1124097H }}</ref> *[[Catecholamine]]s **[[Dopamine]] **[[Dobutamine]] **[[Dopexamine]] **[[Adrenaline]] (epinephrine) **[[Isoproterenol]] (isoprenaline) **[[Norepinephrine (medication)|Noradrenaline]] (norepinephrine) *[[Angiotensin II]] *[[Eicosanoid]]s **[[Prostaglandin]]s<ref name="pmid1314558">{{cite journal | vauthors = Schrรถr K, Hohlfeld T | title = Inotropic actions of eicosanoids | journal = Basic Research in Cardiology | volume = 87 | issue = 1 | pages = 2โ11 | year = 1992 | pmid = 1314558 | doi = 10.1007/BF00795384 | s2cid = 29440212 }}</ref> *[[Phosphodiesterase inhibitors]] **[[Enoximone]] **[[Milrinone]] **[[Amrinone]] **[[Theophylline]] *[[Glucagon]] *[[Insulin]]
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