{{Short description|Class of chemical compound}}
A '''cardiac stimulant''' is a drug which acts as a stimulant of the heart to increase cardiac output. They can work via positive chronotropic action (increased heart rate) and/or positive inotropic action (increased myocardial contractility).
Within positive inotropes, there are calcium mobilizers and calcium sensitizers.<ref name="PolleselloPappPapp2016">{{cite journal | vauthors = Pollesello P, Papp Z, Papp JG | title = Calcium sensitizers: What have we learned over the last 25 years? | journal = Int J Cardiol | volume = 203 | issue = | pages = 543–548 | date = January 2016 | pmid = 26580334 | doi = 10.1016/j.ijcard.2015.10.240 | url = }}</ref><ref name="GeLiMcNamara2019">{{cite journal | vauthors = Ge Z, Li A, McNamara J, Dos Remedios C, Lal S | title = Pathogenesis and pathophysiology of heart failure with reduced ejection fraction: translation to human studies | journal = Heart Fail Rev | volume = 24 | issue = 5 | pages = 743–758 | date = September 2019 | pmid = 31209771 | doi = 10.1007/s10741-019-09806-0 | url = }}</ref><ref name="NagyPolleselloPapp2014">{{cite journal | vauthors = Nagy L, Pollesello P, Papp Z | title = Inotropes and inodilators for acute heart failure: sarcomere active drugs in focus | journal = J Cardiovasc Pharmacol | volume = 64 | issue = 3 | pages = 199–208 | date = September 2014 | pmid = 24785346 | pmc = 4232335 | doi = 10.1097/FJC.0000000000000113 | url = }}</ref> Calcium mobilizers are conventional positive inotropes that elevate intracellular calcium, whereas calcium sensitizers do not elevated intracellular calcium but instead increase sensitivity to it.<ref name="PolleselloPappPapp2016" /><ref name="GeLiMcNamara2019" /><ref name="NagyPolleselloPapp2014" />
Cardiac stimulants are known to be used (and banned) as performance-enhancing drugs, including for doping in sport.<ref name="Docherty2008">{{cite journal | vauthors = Docherty JR | title = Pharmacology of stimulants prohibited by the World Anti-Doping Agency (WADA) | journal = Br J Pharmacol | volume = 154 | issue = 3 | pages = 606–622 | date = June 2008 | pmid = 18500382 | pmc = 2439527 | doi = 10.1038/bjp.2008.124 | url = }}</ref><ref name="DochertyAlsufyani2021">{{cite journal | vauthors = Docherty JR, Alsufyani HA | title = Pharmacology of Drugs Used as Stimulants | journal = J Clin Pharmacol | volume = 61 Suppl 2 | issue = | pages = S53–S69 | date = August 2021 | pmid = 34396557 | doi = 10.1002/jcph.1918 | url = }}</ref>
==Examples== * Sympathomimetics ** β<sub>1</sub>-Adrenergic receptor agonists like epinephrine, norepinephrine, dopamine, dobutamine, denopamine, isoproterenol, and xamoterol<ref name="OvergaardDzavík2008">{{cite journal | vauthors = Overgaard CB, Dzavík V | title = Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease | journal = Circulation | volume = 118 | issue = 10 | pages = 1047–56 | date = September 2008 | pmid = 18765387 | doi = 10.1161/CIRCULATIONAHA.107.728840 | url = }}</ref><ref name="Morrill2000">{{cite journal | vauthors = Morrill P | title = Pharmacotherapeutics of positive inotropes | journal = AORN J | volume = 71 | issue = 1 | pages = 173–8, 181–5; quiz 186–8, 190–2 | date = January 2000 | pmid = 10686650 | doi = 10.1016/s0001-2092(06)62180-7 | url = }}</ref> ** Indirectly acting adrenergic agonists (via activation of β<sub>1</sub>-adrenergic receptors)<ref name="MladěnkaApplováPatočka2018" /> *** Norepinephrine prodrugs like droxidopa (<small>L</small>-DOPS) *** Norepinephrine reuptake inhibitors like atomoxetine, reboxetine, desipramine, nortriptyline, bupropion, milnacipran, methylphenidate, and cocaine<ref name="MladěnkaApplováPatočka2018" /> *** Norepinephrine releasing agents like amphetamine, methamphetamine, ephedrine, pseudoephedrine, phenylpropanolamine, and mephentermine<ref name="MladěnkaApplováPatočka2018" /> * Sympatholytics ** α<sub>1</sub>-Adrenergic receptor antagonists like phentolamine, prazosin, terazosin, and doxazosin<ref name="MladěnkaApplováPatočka2018" /> ** α<sub>2</sub>-Adrenergic receptor antagonists like phentolamine, yohimbine, and atipamezole<ref name="MladěnkaApplováPatočka2018">{{cite journal | vauthors = Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M | title = Comprehensive review of cardiovascular toxicity of drugs and related agents | journal = Med Res Rev | volume = 38 | issue = 4 | pages = 1332–1403 | date = July 2018 | pmid = 29315692 | pmc = 6033155 | doi = 10.1002/med.21476 | url = }}</ref> * Antimuscarinic anticholinergics like atropine<ref name="MladěnkaApplováPatočka2018" /> * Adenosine receptor antagonists like caffeine, theophylline, and aminophylline<ref name="MladěnkaApplováPatočka2018" /> * Phosphodiesterase PDE3 inhibitors like amrinone, milrinone, and pimobendan<ref name="OvergaardDzavík2008" /><ref name="Morrill2000" /><ref name="MladěnkaApplováPatočka2018" /> * Cardiac glycosides like digoxin<ref name="Morrill2000" /> * Calcium sensitizers like levosimendan, pimobendan, and omecamtiv mecarbil * Other agents like hydralazine and cannabinoids<ref name="MladěnkaApplováPatočka2018" />
Exercise is a cardiac stimulant by increasing levels of the sympathomimetic catecholamines epinephrine and norepinephrine.<ref name="Hackney2006">{{cite journal | vauthors = Hackney AC | title = Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress | journal = Expert Rev Endocrinol Metab | volume = 1 | issue = 6 | pages = 783–792 | date = November 2006 | pmid = 20948580 | pmc = 2953272 | doi = 10.1586/17446651.1.6.783 | url = }}</ref><ref name="Grosman-RimonWrightSabovich2023">{{cite journal | vauthors = 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 | title = Relationships among norepinephrine levels, exercise capacity, and chronotropic responses in heart failure patients | journal = Heart Fail Rev | volume = 28 | issue = 1 | pages = 35–45 | date = January 2023 | pmid = 35325323 | doi = 10.1007/s10741-022-10232-y | url = }}</ref>
==References== {{Reflist}}
==External links== * {{Commonscatinline|Cardiac stimulants}}
{{Major drug groups}} {{Cardiac stimulants excluding cardiac glycosides}}
Category:Cardiac stimulants