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Table 2 Receptor pharmacology and physiology affecting the right heart

From: Essential right heart physiology for the perioperative practitioner POQI IX: current perspectives on the right heart in the perioperative period

Medication

Receptor site action

Clinical relevance

Phenylephrine

(10 mcg/min–200 mcg/min)

Pure α1 receptor agonist

Increases systemic vascular resistance (SVR), potential to increase pulmonary vascular resistance

Norepinephrine

(0.02 mcg/kg/min–0.3 mcg/kg/min

Or (1–20 mcg/min)

 α1, β1 receptor agonist

Increases in SVR may have some effect on contractility and HR

Epinephrine

(0.02 mcg/kg/min–0.3 mcg/kg/min)

Or (1–20 mcg/min)

α1, β1, β2 receptor agonist

Increases SVR, increases HR, increases contractility

Dobutamine

(0.5 mcg/kg/min–20 mcg/kg/min)

β1, β2 receptor agonist

Increases HR, increases contractility, may lead to hypotension in some patients

Dopamine (0.5 mcg/kg/min–10 mcg/kg/min)

δ1, α1, β1, β2 agonist

Increases SVR, Increased HR, Increased contractility

Isoproterenol (2–10 mcg/min)

β1, β2 agonist

Increases HR, increases contractility

Milrinone

(0.1 mcg/kg/min–0.5 mcg/kg/min)

Phosphodiesterase III inhibitor

Increases contractility and decreases pulmonary vascular resistance (PVR), may lead to hypotension

Vasopressin

(0.02 U/min–0.04 U/min)

V1 receptor agonist

Increases SVR through splanchnic vessels, no effect on pulmonary vasculature can counteract Milrinone-induced decreases in SVR, no effect on HR

Inhaled Nitric Oxide (1–20 PPM)

Activates soluble guanylate cyclase

Decreases PVR

Inhaled Epoprostenol (0.01–0.1 mcg/kg/min)

Synthetic prostacyclin

Decreases PVR