Acute circulatory effects of dopamine in patients with pulmonary hypertension.

Holloway, Earl L.; Polumbo, Ralph A.; Harrison, D C

doi:10.1136/hrt.37.5.482

Cited by 66 publications

(13 citation statements)

References 6 publications

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“…This suggests that the dopaminergic receptors stimulated at low doses of DA infusion probably do not induce vasodilation of IPAVA, while the higher concentrations that stimulate ␣-adrenergic receptors could theoretically be preventing IPAVA from fully opening. This seems unlikely, however, because the DA concentration used in the current study has not been shown to cause pulmonary vasoconstriction (20) and is not expected to significantly increase flow or pressure (17), which is supported by our data.…”

Section: Subject Characterization and Lung Functionsupporting

confidence: 79%

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Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest

Laurie

Elliott

Goodman

et al. 2012

Journal of Applied Physiology

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The mechanism or mechanisms that cause intrapulmonary arteriovenous anastomoses (IPAVA) to either open during exercise in subjects breathing room air and at rest when breathing hypoxic gas mixtures, or to close during exercise while breathing 100% oxygen, remain unknown. During conditions when IPAVA are open, plasma epinephrine (EPI) and dopamine (DA) concentrations both increase, potentially representing a common mechanism. The purpose of this study was to determine whether EPI or DA infusions open IPAVA in resting subjects breathing room air and, subsequently, 100% oxygen. We hypothesized that these catecholamine infusions would open IPAVA. We performed saline-contrast echocardiography in nine subjects without a patent foramen ovale before and during serial EPI and DA infusions while breathing room air and then while breathing 100% oxygen. Bubble scores (0-5) were assigned based on the number and spatial distribution of bubbles in the left ventricle. Pulmonary artery systolic pressure (PASP) was estimated using Doppler ultrasound, while cardiac output (Q(C)) was measured using echocardiography. Bubble scores were significantly greater during EPI infusions of 80-320 ng·kg(-1)·min(-1) compared with baseline when subjects breathed room air; however, bubble scores did not increase when they breathed 100% oxygen. At comparable Q(C) and PASP, intravenous DA (16 μg·kg(-1)·min(-1)) and EPI (40 ng·kg(-1)·min(-1)) resulted in identical bubble scores. Subsequent studies revealed that β-blockade did not prevent hypoxia-induced opening of IPAVA. We suggest that increases in Q(C) or PASP (or both) secondary to EPI or DA infusions open IPAVA in normoxia. The closing mechanism associated with breathing 100% oxygen is independent from the opening mechanisms.

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Section: Subject Characterization and Lung Functionsupporting

confidence: 79%

“…Binding to dopaminergic receptors on renal vascular smooth muscle induces vasodilation (36), as do higher doses of 5 and 10 g•kg Ϫ1 •min Ϫ1 (9). In the pulmonary circulation DA has been shown either to have no effect (20), or to increase (15) or decrease (47) vascular resistance.…”

mentioning

confidence: 99%

Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest

Laurie

Elliott

Goodman

et al. 2012

Journal of Applied Physiology

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“…Milrinone, a selective PDE3 inhibitor, slows intracellular cyclic adenosine monophosphate (cAMP) metabolism, improves inotropy, and facilitates pulmonary vasodilation. It is an attractive agent to use in PH resulting from biventricular failure [ 82 ] and would also be preferable to use in normotensive patients on chronic beta-blocker therapy. Inhaled milrinone has also been investigated for the management of RHF, as it avoids the side effect of systemic hypotension.…”

Section: The Treatment Of Rvfmentioning

confidence: 99%

The Dark Side of the Moon: The Right Ventricle

Foschi

Mauro

Tancredi

et al. 2017

JCDD

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The aim of this review article is to summarize current knowledge of the pathophysiology underlying right ventricular failure (RVF), focusing, in particular, on right ventricular assessment and prognosis. The right ventricle (RV) can tolerate volume overload well, but is not able to sustain pressure overload. Right ventricular hypertrophy (RVH), as a response to increased afterload, can be adaptive or maladaptive. The easiest and most common way to assess the RV is by two-dimensional (2D) trans-thoracic echocardiography measuring surrogate indexes, such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and tissue Doppler velocity of the lateral aspect of the tricuspid valvular plane. However, both volumes and function are better estimated by 3D echocardiography and cardiac magnetic resonance (CMR). The prognostic role of the RV in heart failure (HF), pulmonary hypertension (PH), acute myocardial infarction (AMI), and cardiac surgery has been overlooked for many years. However, several recent studies have placed much greater importance on the RV in prognostic assessments. In conclusion, RV dimensions and function should be routinely assessed in cardiovascular disease, as RVF has a significant impact on disease prognosis. In the presence of RVF, different therapeutic approaches, either pharmacological or surgical, may be beneficial.

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“…At doses below 16 g kg Ϫ1 min Ϫ1 ), dopamine increases CO without worsening PVR. 37,38 Dobutamine is another inotrope that acts via ␤ 1 receptor stimulation, but may also cause vasodilatation due to ␤ 2 effects. At low doses (5 to 10 g kg Ϫ1 min Ϫ1 ), dobutamine improves PA/RV coupling in animal studies and improves myocardial contractility and PVR in patients with left heart failure.…”

Section: Inotropesmentioning

confidence: 99%

Sepsis and Pulmonary Arterial Hypertension in the ICU

Chan

Klinger

2015

Advances in Pulmonary Hypertension

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The management of sepsis in the patient with pulmonary arterial hypertension (PAH) is dependent on 2 primary principles: 1) optimizing right ventricular (RV) function, and 2) reducing pulmonary vascular resistance. In this review, we will discuss the major challenges that health care providers face in trying to achieve these goals. We will start with an overview of normal RV function and modulators of pulmonary vascular tone. A general approach to managing RV failure and hemodynamic instability will be provided, along with a discussion of how modern therapies for the treatment of PAH can best be used in the setting of sepsis.

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Acute circulatory effects of dopamine in patients with pulmonary hypertension.

Cited by 66 publications

References 6 publications

Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest

Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest

The Dark Side of the Moon: The Right Ventricle

Sepsis and Pulmonary Arterial Hypertension in the ICU

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