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Patients in the intensive care unit frequently develop low-output syndromes due to cardiac dysfunction, myocardial injury and activation of inflammatory cascades. Pharmacological agents, including vasodilators, inotropes and vasopressors, are frequently used in the critical care setting for the management of unstable cardiac patients. These medications are used to elicit varying effects on vascular resistance, myocardial contractility and heart rate to achieve desired hemodynamic and clinical end points. Conventional inotropic agents appear to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion, but they can increase short-term and long-term mortality in these patients. Novel inotropes may be promising in the management of cardiogenic shock patients without serious adverse effects. The present review summarizes the current knowledge about the pathophysiology and evidence-based use of conventional and novel inotropic agents in various clinical scenarios associated with cardiovascular diseases.