Vascular Dilation, Tachycardia, and Increased Inotropy Occur Sequentially with Increasing Epinephrine Dose Rate, Plasma and Myocardial Concentrations, and cAMP

Heart, Lung & Circulation
Mikhail Y MaslovMark A Lovich

Abstract

While epinephrine infusion is widely used in critical care for inotropic support, there is no direct method to detect the onset and measure the magnitude of this response. We hypothesised that surrogate measurements, such as heart rate and vascular tone, may indicate if the plasma and tissue concentrations of epinephrine and cAMP are in a range sufficient to increase myocardial contractility. Cardiovascular responses to epinephrine infusion (0.05-0.5 mcgkg(-1)min(-1)) were measured in rats using arterial and left ventricular catheters. Epinephrine and cAMP levels were measured using ELISA techniques. The lowest dose of epinephrine infusion (0.05 mcgkg(-1)min(-1)) did not raise plasma epinephrine levels and did not lead to cardiovascular response. Incremental increase in epinephrine infusion (0.1 mcgkg(-1)min(-1)) elevated plasma but not myocardial epinephrine levels, providing vascular, but not cardiac effects. Further increase in the infusion rate (0.2 mcgkg(-1)min(-1)) raised myocardial tissue epinephrine levels sufficient to increase heart rate but not contractility. Inotropic and lusitropic effects were significant at the infusion rate of 0.3 mcgkg(-1)min(-1). Correlation of plasma epinephrine to haemodynamic parameters sug...Continue Reading

References

Jun 1, 1988·Circulation·D A Kass, W L Maughan
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Jun 1, 1994·Critical Care Medicine·A D BerstenA H Ilsley

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Citations

Dec 2, 2017·Physiological Reports·Alex J MattinglyThomas L Clanton
Nov 22, 2018·American Journal of Physiology. Heart and Circulatory Physiology·Mikhail Y MaslovMark A Lovich
Nov 20, 2019·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Hannah N KuharJohn R Craig
Mar 29, 2020·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·John Jacob BarnesMojca R Konia
Jul 5, 2019·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Jon B ColeBrian E Driver
Jun 27, 2020·Plastic and Reconstructive Surgery·Uri FarkashAvishag Laish-Farkash

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