Acute Heart failure (AHF), clinical signs of low cardiac output, therapy with positive inotropic drug for cardiac care is mandatory. Three classes of inotropic drugs are currently available, like β-adrenergic agonists (especially dobutamine), phosphodiesterase (PDE) inhibitors (such as milrinone) and Ca²⁺ sensitizers (levosimendan). The mechanisms of action of these drugs, and important issues regarding their clinical indications and potential risks associated with their use are studied. Oral inotropes did not always improve mortality of the patients with heart failure (HF) partly because of possible direct toxic effects of these agents on myocytes, exacerbating arrhythmias, enhancing neurohormonal activity. Ca²⁺ sensitizers such as pimobendan and levosimendan were improve even mortality of the patients with HF through increasing cardiac contractility (CC) without a rise in (Ca²⁺)i. However, these agents disappoint our expectations. We need the development of the agents which has more specific effect of Ca²⁺ sensitizing.

calcium sensitizers, ionotrpic, heart failure