Milrinone also works to vasodilate which helps alleviate increased pressures (afterload) on the heart, thus improving its pumping action.

While it has been used in people with heart failure for many years, studies suggest that milrinone may exhibit some negative side effects that have caused some debate about its use clinically.

Some of the main problems associated with decreased contractility in those with heart failure are issues arising from imbalances in the concentration of calcium.

This reduction in cardiac output can cause many systemic implications such as fatigue, syncope and other issues associated with decreased blood flow to peripheral tissues.

PKA also phosphorylates components on myofilaments allowing actin and myosin to interact more easily and thus increasing contractility and the inotropic state of the heart.

Milrinone allows stimulation of cardiac function independently of β-adrenergic receptors which appear to be down-regulated in those with heart failure.

[13] Milrinone is a commonly used therapy for severe pulmonary arterial hypertension (PAH),[14] often in combination with other medications such as sildenafil.

[16] It can be used in cardiopulmonary bypass cases, as it increases the flow in saphenous grafts and has a beneficiary effect in left ventricle function.