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Figure 1  .

Figure 1  

Site of action of various inotropic agents. Most of the conventional inotropes increase cyclic adenosine monophosphate (cAMP), with a subsequent increase in intracellular calcium ion concentration which enhances contraction. However, increased calcium ion concentrations may promote arrhythmias, particularly during ischaemia and reperfusion. Calcium sensitisers such as levosimendan, pimobendan, and EMD 53998 may enhance myocardial contraction without increasing intracellular calcium ion concentration and the associated risk of increased arrhythmias. AMP, adenosine monophosphate; ATP, adenosine triphosphate; PDE, phosphodiesterase.