Cardiac stimulant explained

A cardiac stimulant is a drug which acts as a stimulant of the heart – e.g., via positive chronotropic action (increased heart rate) and/or inotropic action (increased myocardial contractility). They increase cardiac output (the amount of blood pumped by the heart over time).

Examples

• β₁-Adrenergic receptor agonists like epinephrine, norepinephrine, dopamine, dobutamine, denopamine, isoproterenol, and xamoterol^{[1] [2]}
• Adrenergic agents indirectly activating β₁-adrenergic receptors
  • Norepinephrine prodrugs like droxidopa
  • Norepinephrine reuptake inhibitors like atomoxetine, reboxetine, desipramine, nortriptyline, bupropion, milnacipran, methylphenidate, and cocaine
  • Norepinephrine releasing agents like amphetamine, methamphetamine, ephedrine, pseudoephedrine, phenylpropanolamine, and mephentermine
• α₁-Adrenergic receptor antagonists like phentolamine, prazosin, terazosin, and doxazosin
• α₂-Adrenergic receptor antagonists like phentolamine, yohimbine, and atipamezole^[3]
• Antimuscarinic anticholinergics like atropine
• Adenosine receptor antagonists like caffeine, theophylline, and aminophylline
• PDE3 inhibitors like amrinone, milrinone, and pimobendan
• Cardiac glycosides like digoxin
• Other agents like hydralazine, levosimendan, and cannabinoids

Exercise is also a cardiac stimulant by increasing levels of the sympathomimetic catecholamines epinephrine and norepinephrine.^{[4] [5]}

Notes and References

1. Overgaard CB, Dzavík V . Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease . Circulation . 118 . 10 . 1047–56 . September 2008 . 18765387 . 10.1161/CIRCULATIONAHA.107.728840 .
2. Morrill P . Pharmacotherapeutics of positive inotropes . AORN J . 71 . 1 . 173–8, 181–5; quiz 186–8, 190–2 . January 2000 . 10686650 . 10.1016/s0001-2092(06)62180-7 .
3. Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M . Comprehensive review of cardiovascular toxicity of drugs and related agents . Med Res Rev . 38 . 4 . 1332–1403 . July 2018 . 29315692 . 6033155 . 10.1002/med.21476 .
4. Hackney AC . Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress . Expert Rev Endocrinol Metab . 1 . 6 . 783–792 . November 2006 . 20948580 . 2953272 . 10.1586/17446651.1.6.783 .
5. Grosman-Rimon L, Wright E, Sabovich S, Rimon J, Gleitman S, Sudarsky D, Lubovich A, Gabizon I, Lalonde SD, Tsuk S, McDonald MA, Rao V, Gutterman D, Jorde UP, Carasso S, Kachel E . Relationships among norepinephrine levels, exercise capacity, and chronotropic responses in heart failure patients . Heart Fail Rev . 28 . 1 . 35–45 . January 2023 . 35325323 . 10.1007/s10741-022-10232-y .