Question:
Which among the following is the best inotrope drug for use in right heart failure due to pulmonary hypertension?
Which among the following is the best inotrope drug for use in right heart failure due to pulmonary hypertension?
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Look for the inodilator that also lowers pulmonary vascular resistance.
Updated On: Jun 24, 2026
- Dopamine
- Isoprenaline
- Halothane
- Milrinone
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The Correct Option is D
Solution and Explanation
Step 1: Define the clinical problem. Right heart failure from pulmonary hypertension needs a drug that increases right ventricular contractility while reducing pulmonary vascular resistance (afterload on the right ventricle).
Step 2: Recall milrinone's mechanism. Milrinone is a phosphodiesterase-3 inhibitor; it raises intracellular cyclic AMP, producing positive inotropy in the heart and vasodilation in the systemic and pulmonary vasculature. This combination is described as an inodilator.
Step 3: Apply this to the right ventricle. By lowering pulmonary vascular resistance, milrinone unloads the failing right ventricle while also strengthening its contraction, which is exactly what is needed here.
Step 4: Eliminate the others. Dopamine, especially at higher doses, can raise pulmonary vascular resistance and cause tachyarrhythmias. Isoprenaline is a non-selective beta agonist causing marked tachycardia. Halothane is an inhalational anaesthetic and a myocardial depressant, not an inotrope.
Answer: Option D, Milrinone.
Step 2: Recall milrinone's mechanism. Milrinone is a phosphodiesterase-3 inhibitor; it raises intracellular cyclic AMP, producing positive inotropy in the heart and vasodilation in the systemic and pulmonary vasculature. This combination is described as an inodilator.
Step 3: Apply this to the right ventricle. By lowering pulmonary vascular resistance, milrinone unloads the failing right ventricle while also strengthening its contraction, which is exactly what is needed here.
Step 4: Eliminate the others. Dopamine, especially at higher doses, can raise pulmonary vascular resistance and cause tachyarrhythmias. Isoprenaline is a non-selective beta agonist causing marked tachycardia. Halothane is an inhalational anaesthetic and a myocardial depressant, not an inotrope.
Answer: Option D, Milrinone.
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