Heart failure is a prevalent and complex medical condition affecting over 60 million patients worldwide, and poses a significant risk of mortality in the elderly. The calcium sensitizing drug levosimendan and the phosphodiesterase 3 inhibitor milrinone are among the inotropic drugs which are currently employed in clinical practice to treat heart failure, whereas the myosin activator drug omecamtive mecarbil has not yet been approved for use in Europe and the United States despite the promising potential to reduce the mortality in severe heart failure patients. Levosimendan has been shown to improve survival rate and reduce hospitalization duration thanks to its inotropic and cardioprotective effects, however, caution should be taken when used in hypotensive patients. According to the guidelines, the use of milrinone should be limited to short-term use due to the potential arrhythmogenic effects which may result from the alteration of intracellular calcium.