In the management of acute decompensated heart failure, which therapy directly improves cardiac output?

Milrinone therapy is known for its ability to directly improve cardiac output in patients with acute decompensated heart failure. Milrinone is a phosphodiesterase-3 inhibitor which leads to increased levels of cyclic AMP in cardiac myocytes. This mechanism enhances the contractility of the heart, also known as positive inotropic effect, and promotes vasodilation, which reduces the afterload on the heart. Consequently, this results in increased stroke volume and overall cardiac output, making it particularly effective in managing acute heart failure where there is significant impairment in cardiac function.

Other therapies, while potentially useful in heart failure management, do not primarily focus on directly improving cardiac output. For instance, dopamine can provide inotropic support in certain situations, but its efficacy can vary based on dosage and patient response. High-dose furosemide primarily acts to reduce fluid overload and improve congestion rather than increasing cardiac output. Outpatient diuretics are used to manage chronic fluid retention but do not enhance myocardial contractility or cardiac performance in the acute setting. Therefore, milrinone is the preferred choice for directly addressing the issue of low cardiac output in acute decompensated heart failure.