Inotropic agent | RV inotropy | PVR | PVR with sPA vasodilator | SVR | TSG | CO | Comments |
Alpha-agonist (eg, phenylephrine) | ←→ | ↑↑ | ↓↓ | ↑↑ | ←→ | ↓ | Indicated only as bolus dose treatment of acute hypotension, while the typical RV-support regime is prepared. |
Vasopressin (VP) | ←→ | ←→ | ↓ | ↑↑ | ←→/↑ | ←→/↑ | Ideal pressor agent in right-sided shock due to minimal effect on PVR. The increased LV pressure pushes the septum back to the R, increases RCA blood flow. |
Phosphodiesterase inhibitors (PDE3I) (eg, milrinone) | ↑↑ | ↓↓ | ↓↓ | ↓↓ | ↓↓ | ↑ ↓ | Good inotrope but potentially dangerous decrease in SBP and TSG. MUST start with VP "ready to go". |
Beta-1,2 agonists (eg, dopamine, dobutamine) | ↑↑ | ↓ | ↓ | ↓ | ↓ | ↑ ↓ | Good inotrope and less effect on SVR, SBP, and TSG at lower doses. Also have VP "ready to go". |
Calcium sensitizers (eg, levosimendan) | ↑↑ | ↓↓ | ↓↓ | ↓↓ | ↓↓ | ↑ | Similar risk to PDE3I with regards to SVR; there is limited experience in acute right-sided shock. |
Combination of inotropes + vasopressin | ↑↑ | ↓↓ | ↓↓ | ←→/↑ | ←→ | ↑ | Combination of lower dose PDE3I and Beta-1,2 agonists have additive effects, but less profound decrease in SVR. Adding VP mitigates SVR with minimal effect on PVR. |
Do you want to add Medilib to your home screen?