Which additional intervention is most appropriate to support right ventricular function in a hospitalized PAH patient?

In the context of supporting right ventricular function in a hospitalized patient with pulmonary arterial hypertension (PAH), the administration of milrinone is particularly appropriate due to its specific pharmacological properties. Milrinone is a phosphodiesterase-3 (PDE-3) inhibitor that results in increased intracellular cAMP levels, leading to enhanced myocardial contractility and vasodilation.

In patients with PAH, the right ventricle can become strained due to elevated pulmonary pressures. Milrinone not only improves contractility, thereby aiding the heart’s ability to pump effectively but also promotes peripheral vasodilation, reducing the afterload that the right ventricle must overcome. This dual effect is essential in managing right ventricular dysfunction, which is a common complication associated with PAH.

Milrinone is often chosen in specialized settings for its ability to optimize right ventricular function while also offering some anxiolytic effects on the vascular system. This makes it particularly valuable in an acute care setting for patients with severe PAH who may be experiencing right heart failure.

In contrast, other options do not provide the same targeted benefit for right ventricular support in the setting of PAH. For instance, dobutamine primarily enhances cardiac output through increased contractility but may not