n.

変力物質
a drug with positive inotropic effects, e.g. dobutamine, digitalis, milrinone

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/14 14:26:55」(JST)

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Not to be confused with ionotropic.

An inotrope (pron.: /ˈaɪnɵtroʊp/; from Greek in-, meaning fibre or sinew) is an agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular contraction.

The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.

Cardiac inotropes [edit]

Both positive and negative inotropes are used in the management of various cardiovascular conditions. The choice of agent depends largely on specific pharmacological effects of individual agents with respect to the condition. One of the most important factors affecting inotropic state is the level of calcium in the cytoplasm of the muscle cell. Positive inotropes usually increase this level, while negative inotropes decrease it. However, not all drugs involve calcium release, and, among those that do, the mechanism for manipulating the calcium level can vary from drug to drug.

Positive inotropic agents [edit]

Positive inotropic agents increase myocardial contractility, and are used to support cardiac function in conditions such as decompensated congestive heart failure, cardiogenic shock, septic shock, myocardial infarction, cardiomyopathy, etc.

Examples of positive inotropic agents include:

Berberine
Calcium
Calcium sensitisers
- Levosimendan
Cardiac myosin activators
- Omecamtiv
Catecholamines
- Dopamine
- Dobutamine
- Dopexamine
- Epinephrine (adrenaline)
- Isoprenaline (isoproterenol)
- Norepinephrine (noradrenaline)
Digoxin
Digitalis
Eicosanoids
- Prostaglandins^[1]
Phosphodiesterase inhibitors
- Enoximone
- Milrinone
- Amrinone
- Theophylline
Glucagon
Insulin

Negative inotropic agents [edit]

Negative inotropic agents decrease myocardial contractility, and are used to decrease cardiac workload in conditions such as angina. While negative inotropism may precipitate or exacerbate heart failure, certain beta blockers (e.g. carvedilol, bisoprolol and metoprolol) have been believed to reduce morbidity and mortality in congestive heart failure. Quite recently, however, the effectiveness of beta blockers has come under renewed critical scientific scrutiny.

Beta blockers
Calcium channel blockers
- Diltiazem
- Verapamil
- Clevidipine

Class IA antiarrhythmics such as

Quinidine
Procainamide
disopyramide

Class IC antiarrhythmics such as

Flecainide

References [edit]

^ Schrör K, Hohlfeld T (1992). "Inotropic actions of eicosanoids". Basic Res. Cardiol. 87 (1): 2–11. doi:10.1007/BF00795384. PMID 1314558.

UpToDate Contents

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1. 昇圧剤および強心剤の使用 use of vasopressors and inotropes
2. 収縮能障害による心不全における強心剤 inotropic agents in heart failure due to systolic dysfunction
3. Weaning from cardiopulmonary bypass (CPB)
4. 周産期心筋症：治療および予後 peripartum cardiomyopathy treatment and prognosis
5. 急性非代償性心不全の治療：治療の要素 treatment of acute decompensated heart failure components of therapy

English Journal

Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study).

Iqbal MB1, Al-Hussaini A2, Rosser G2, Salehi S2, Phylactou M2, Rajakulasingham R2, Patel J2, Elliott K2, Mohan P2, Green R2, Whitbread M3, Smith R2, Ilsley C2.
The American journal of cardiology.Am J Cardiol.2015 Mar 15;115(6):730-7. doi: 10.1016/j.amjcard.2014.12.033. Epub 2015 Jan 6.
Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OO
PMID 25644852

Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism.

Kukla P1, McIntyre WF2, Koracevic G3, Kutlesic-Kurtovic D3, Fijorek K4, Atanaskovic V3, Krupa E5, Mirek-Bryniarska E6, Jastrzębski M7, Bryniarski L7, Pruszczyk P8, Baranchuk A9.
The American journal of cardiology.Am J Cardiol.2015 Mar 15;115(6):825-30. doi: 10.1016/j.amjcard.2014.12.049. Epub 2015 Jan 6.
Atrial fibrillation (AF) can induce a hypercoagulable state in both the left and right atria. Thrombus in the right side of the heart (RHT) may lead to acute pulmonary embolism (APE). The aim of the study was to determine the prevalence of RHT and AF and to assess their impact on outcomes in patient
PMID 25638519

Posterior restoration procedures and the long-term results in indicated patients with dilated cardiomyopathy†

Isomura T1, Hirota M2, Notomi Y2, Hoshino J2, Kondo T2, Takahashi Y2, Yoshida M2.
Interactive cardiovascular and thoracic surgery.Interact Cardiovasc Thorac Surg.2015 Mar 3. pii: ivv019. [Epub ahead of print]
OBJECTIVES: Non-transplant surgery for dilated cardiomyopathy (DCM) has been in the process of development. We performed posterior restoration for dilated akinetic or dyskinetic lesions in patients with DCM and obtained favourable outcomes. The early and long-term results of the procedures are discu
PMID 25736271

Japanese Journal

修正大血管転位・右胸心に合併した最重症心不全に対し心臓再同期療法が著効した1例

杉山裕章,今井靖,海老原文,藤生克仁,平田恭信,永井良三,田中信大,山科章
心電図 = Electrocardiology 30(1), 63-72, 2010-03-10
症例は41歳，男性．生後，修正大血管転位（C-TGA），心室中隔欠損（VSD），右胸心の指摘を受け，2歳時にVSD閉鎖術，33歳時に三尖弁置換術（TVR）が施行された．以後，心機能低下はあるものの心不全の顕在化なく経過していたが，2008年10月，突然心肺停止となった．搬送先で蘇生されたが，体心室（解剖学的右室）の収縮能低下を伴う心不全管理に難渋し，カテコラミン依存状態となった．当院転院後，非薬物 …
NAID 10026410804

PE-340 International Comparison of Clinical Use of Inotrope and Vasodilator Therapy for Acute Decompensated Heart Failure(Heart failure, clinical(10)(M),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

Yokoyama Hiroyuki,Hashimura Kazuhiko,Nakatani Satoshi,Kitakaze Masafumi,Goto Yoichi,Nonogi Hiroshi
Circulation journal : official journal of the Japanese Circulation Society 72(Supplement_I), 445, 2008-03-01
NAID 110006798229

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 76」

「100Cases 76」

　　[★]

☆case76　頭痛

■glossary

傾眠 drowsiness 正常、病的の区別なく眠り込む場合に用いられる

意識不鮮明　 confusion 周囲に対する認識や理解は低下し、思考の清明さや、記憶の正確さが失われる

錯乱　 confusion　夢幻様状態より見当識障害と思考の滅裂が見られる状態(PSY.40)

MA = Master of Arts 文学修士

　The Master of Arts (BrE: MA, UsE: M.A.) is awarded in Arts, Humanities, Theology and Social Sciences (Wikipedia)

graduate student 大学院生

rousable adj. 覚醒できる、目を覚ますことができる

rouse vt. ～の目を覚まさせる、呼び起こす。喚起する、鼓舞する、奮起させる。(感情を)起こさせる、かき立てる

lateralize vt. (生理)(大脳が)(左右半球に心的機能差がある、左右差がある。(器官・機能・活動などが)大脳の(左右いずれかの)片側優位下にある。(医学)(障害などが)大脳の片半球にあると診断される

乳頭浮腫 papilledema 原因を問わず視神経乳頭が腫脹している状態

うっ血乳頭 choked disc 脳圧亢進による乳頭浮腫

■症例

24歳、男性　精神学の修士過程を専攻している大学院生

主訴：激しい頭痛

現病歴：頭部全体に痛みがある。2回嘔吐。傾眠と錯乱が認められるようになった。明るい光を嫌う()he finds bright lights uncomfortable。

既往歴：病気の既往はない。アレルギーはない。タバコ1日10本。アルコール24 unit/week(缶ビール(350ml)13.7本/週)。薬は服用してない。

家族歴：彼女と同居。3歳と4歳の子供がいる。

・診察 examination

　見た感じ紅潮しており、調子が悪そう。体温：39.2℃。項部硬直あり(he has stiffness on passice flexion of his neck)。皮疹なし。副鼻腔に圧痛なし。鼓膜所見は正常。脈拍：120/分。血圧：98/74 mmHg。心血管系、胸部、腹部に異常所見なし(normal)。意識レベル低下。命令に応じて覚醒する(JCS10？)。局所神経症状認めない。眼底所見正常

・検査 investigation

　血液検査

　　白血球：上昇。血清 Na：低下。血清尿素：上昇。血清クレアチニン：上昇。血液培養：検査中

　画像検査

　　胸部X線：異常所見なし。頭部 CT：正常

　心電図：洞性頻脈

　腰椎穿刺

　　髄液所見：混濁。白血球：増多。蛋白：増多。糖：低下(普通の人の血糖100mg/dLと考える。→　1g/L　→　1/180　mol/L　→　5.56 mmol/L。グラム染色：結果待ち

■Q

　診断、鑑別診断、管理

■A

　細菌性髄膜炎、髄膜炎・クモ膜下出血、経験的抗菌薬投与・