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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Effects of vasoactive agents in right-sided cardiogenic shock

Effects of vasoactive agents in right-sided cardiogenic shock
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.
RV: right ventricle; PVR: pulmonary vascular resistance; sPA: selective pulmonary artery vasodilator (eg, inhaled nitric oxide [NO], inhaled milrinone, inhaled prostanoid, sublingual sildenafil, or combinations of sPA vasodilators); SVR: systemic vascular resistance; TSG: transseptal pressure gradient; CO: cardiac output; VP: vasopressin; LV: left ventricle; RCA: right coronary artery; PDE3I: phosphodiesterase inhibitor; SBP: systolic blood pressure.
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