A patient receives a high intravenous dose of epinephrine. Which hemodynamic sequence best describes the complete cardiovascular response?

• A Increase in HR, increase in diastolic BP, decrease in pulse pressure
• B Decrease in HR, massive rise in diastolic BP, narrowed pulse pressure
• C Unchanged HR, uniform rise in systolic and diastolic BP equally
• D Increase in HR, increase in systolic BP, decrease in diastolic BP, widened pulse pressure ✓

Explanation

Epinephrine activates both alpha-1 and beta-1 receptors: beta-1 stimulation increases heart rate and contractility raising systolic BP, while beta-2 stimulation causes skeletal muscle vasodilation that lowers diastolic BP. The net result is a widened pulse pressure. At low doses beta-2 effects on peripheral vasculature predominate, reducing diastolic BP; at high doses alpha-1 vasoconstriction limits this fall but systolic BP still rises more markedly.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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