Table.
Potential interactions between catecholamines, adrenoceptors, and physiological systems, and implications in patients with COVID-19
| Deleterious effects of catecholamines | Beneficial effects of catecholamines | ||
|---|---|---|---|
| Cardiovascular system | |||
| Arrhythmogenic effects | |||
| β1-AR | adrenaline > noradrenaline: arrhythmias, deteriorate into cardiac arrest; most common arrhythmias: sinus tachycardia, atrial fibrillation or flutter, ventricular tachycardia | .. | |
| Haemodynamic effects | |||
| α1-AR | noradrenaline > adrenaline: vasoconstriction, hypertension | noradrenaline > adrenaline: catecholamine-induced vasoconstriction might compensate for COVID-19-distributive or cardiogenic shock | |
| β1-AR | noradrenaline and adrenaline: renin release and COVID-19-mediated ACE2 degradation; both can lead to increased angiotensin II, potentially resulting in hypertensive crises | noradrenaline and adrenaline: cardiac stimulation might compensate for COVID-19-distributive or cardiogenic shock | |
| β2-AR | adrenaline or noradrenaline with α1-AR blockade: can precipitate hypotensive shock or distributive (septic) shock in patients with COVID-19 | .. | |
| Cardiomyopathic effects | |||
| β1-AR and β2-AR | adrenaline > noradrenaline: acute heart failure or decompensation, takotsubo cardiomyopathy, myocarditis, chronic catecholamine cardiomyopathies | .. | |
| Pulmonary system | |||
| α1-AR | noradrenaline > adrenaline: vasoconstriction to well ventilated alveoli, intrapulmonary shunt, hypoxaemia | noradrenaline > adrenaline: decreased bronchial gland secretion, improved ventilation | |
| β2-AR | adrenaline: vasodilation or opposition to hypoxic vasoconstriction to poorly ventilated alveoli, intrapulmonary shunt, hypoxaemia | adrenaline: bronchodilation, improved ventilation | |
| Haematological system | |||
| β-ARs | noradrenaline and adrenaline: hypercoagulability, thrombosis | adrenaline > noradrenaline: activation of fibrinolysis, anti-thrombotic | |
| α2-AR | adrenaline and noradrenaline: platelet aggregation, thrombosis | .. | |
| Immunological system | |||
| α2-ARs | probably noradrenaline and adrenaline: inhibition of antigen presentation, lymphocyte proliferation, cytokine production, greater susceptibility to SARS-CoV-2 infection | .. | |
| β-ARs | likely adrenaline: lymphopenia and chronic catecholamines cause NK cell reduction | likely adrenaline: acute catecholamine elevation, increased NK cells, improved host viral defence | |
| Endocrine system | |||
| α2-AR | adrenaline > noradrenaline: β-cell dysfunction, hyperglycaemia | adrenaline > noradrenaline: catecholamine-induced hyperglycaemia, could counteract hypoglycaemia in patients with severe COVID-19 infection | |
ACE2=angiotensin-converting enzyme 2. AR=adrenoceptor. NK cell=natural killer cell. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.