The drug treatment of heart failure is changing. Diuretics remain the basic therapy, digoxin still has a place even in patients with sinus rhythm,1,2 but new agents are being used when these fail. They include inotropic agents which increase myocardial contractility, and vasodilator drugs which reduce either the load against which the heart has to work (after-load) by lowering peripheral resistance, or by reducing the central venous pressure (pre-load) by increasing venous compliance. In this article we discuss the sympathomimetic drugs dopamine, dobutamine, prenalterol, salbutamol, rimiterol and pirbuterol. These have inotropic and vasodilator (predominantly arteriolar) properties, or both.
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