Effect of sublingual nitroglycerin in emergency treatment of severe pulmonary edema

Bussmann, W.‐D.; Schupp, D.

doi:10.1016/0002-9149(78)90736-1

Cited by 87 publications

(13 citation statements)

References 13 publications

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“…The CONSENSUS trial [21] and SOLVD trial [22] demonstrated the benefit of enalapril, primarily an after load reducer, in decreasing CHF-associated mortality. Nitrates are primarily venodilators, but also dilate arteries at high doses, and they have been shown to be beneficial in treating acute CHF exacerbations [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

The Role of Thermal Stress on CHF Admissions in a Tropical Climate

Luk¹

2013

Trop Med Surg

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Objectives:A previous study of emergency department visits for Congestive Heart Failure (CHF) to hospitals in New Jersey revealed a marked increase in the colder months. This was attributed in part to increased demands on the heart in response to cold weather. We speculated that the extreme high temperatures in the tropics would place a similar additional burden on the heart. Therefore, we hypothesized an increase in the number of hospital admissions for CHF during the warmest months in the tropics. Methods:Design: Retrospective cohort.Setting: Community hospital in Chennai, Southern India. Participants: All patients ages 15 and older admitted to the hospital fromProtocol: We examined all hospital inpatient discharge diagnoses and selected those for CHF. We analyzed the data by month, testing for statistical significance using Chi Square and Student's t tests with alpha set at 0.05. Results:Of the 6,800 total hospital medical admissions, there were 513 admissions for CHF. Of the CHF visits, 46% were female and the average age was 66 ± 12 years. The four coldest months (average temperature=29°C) had 1.46 (95% CI 1.12-1.79, p=0.015) times more visits than the four warmest months (average temperature=37°C). Conclusion:Contrary to our hypothesis, we found a statistically significant decrease in CHF visits in the warmer months. We speculate that the additional burden imposed by thermal stress on the heart may be more than offset by the vasodilatory effect of high ambient temperatures.

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Section: Discussionmentioning

confidence: 99%

The Role of Thermal Stress on CHF Admissions in a Tropical Climate

Luk¹

2013

Trop Med Surg

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“…Primary end points were the percentage in whom ITR was achieved within 30 minutes and the number whose SBP was below the ITR after 3 minutes of clevidipine infusion. Among the 19 AHF patients in VELOCITY, median time to ITR was 11.3 minutes (95% confidence interval, [7][8][9][10][11][12][13][14][15][16][17][18][19]. ITR was reached in most patients (94%) within 30 minutes.…”

Section: Ahf Patients With Elevated Sbp At Presentationmentioning

confidence: 99%

“…12,13 Accordingly, the clinical target in hypertensive AHF is blood pressure control with early aggressive vasodilation, rather than aggressive diuresis. 15,16 6,8,14 Blood pressure level can be used as a meaningful and easily monitored variable to identify various patient subsets that may benefit from different forms of therapy, as invasive hemodynamic monitoring (eg, pulmonary catheter wedge pressure, cardiac output) is frequently not available in the emergency department for the early management of suspected AHF.…”

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confidence: 99%

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Clevidipine for Severe Hypertension in Acute Heart Failure: A VELOCITY Trial Analysis

Peacock

Varon

Ebrahimi

et al. 2010

Congestive Heart Failure

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Acute severe hypertension occurs in approximately 50% of patients with acute heart failure (AHF). Clevidipine, the latest-generation dihydropyridine calcium channel blocker, may be useful in the treatment of this patient population. The Evaluation of the Effect of Ultra-Short-Acting Clevidipine in the Treatment of Patients With Severe Hypertension (VELOCITY) trial enrolled 126 patients with systolic blood pressure (SBP) >180 mm Hg for treatment with clevidipine to a patient-specific prespecified initial target range (ITR) of SBP to be achieved within 30 minutes. Of the enrolled patients, 19 had AHF on presentation. Primary end points were the percentage in whom ITR was achieved within 30 minutes and the number whose SBP was below the ITR after 3 minutes of clevidipine infusion. Among the 19 AHF patients in VELOCITY, median time to ITR was 11.3 minutes (95% confidence interval, 7-19). ITR was reached in most patients (94%) within 30 minutes. No patient had hypotension below the ITR, and heart rate remained stable. At 18 hours, 16 of 19 patients had received continuous clevidipine infusion, and their SBP was reduced by mean of 50 mm Hg (25%) from baseline. There were no treatment-related adverse events or adverse events that led to clevidipine discontinuation. Clevidipine safely decreases SBP in AHF and does not cause unexpected hypotension. The results of this post hoc subgroup analysis suggest that clevidipine is safe, well tolerated, and efficacious in AHF patients with hypertension.

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“…Early studies with fewer than 30 severe APE patients suggested a rapid decrease in pulmonary artery wedge pressures within 5 minutes of sublingual nitroglycerin (1.6 mg) and improvements in dyspnea and rales within 20 minutes using one to six doses of sub‐lingual nitroglycerin at intervals of 5–10 minutes 41 . A case series of 24 patients found that an aggressive intravenous (IV) nitroglycerin bolus regimen in addition to furosemide led to significant improvement in two thirds of patients within 20 minutes and 83% within 30 minutes without the occurrence of hypotension 42 .…”

Section: Acute Pulmonary Edemamentioning

confidence: 99%

Management of Acute Decompensated Heart Failure in the Emergency Department

Peacock

Allegra

Ander

et al. 2003

Congestive Heart Failure

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Heart failure, a disease of epidemic proportions, has a tremendous clinical and financial impact on the US health care system. With more than 5 million Americans diagnosed with heart failure and 5‐year mortality approaching 50%, it is the most common cause of hospitalization in patients older than 65 years and is the single most expensive diagnosis in the US health care system. Because the average US hospital loses more than $1000 per heart failure admission, effective therapies that decrease length of stay, reduce hospital costs, and prevent 30‐day readmissions are needed. This article reviews the relevant pathophysiology of heart failure, discusses the newest diagnostic strategies for emergency department diagnoses, evaluates recent advances and effects of early aggressive therapies, and presents a suggested algorithm for the treatment of acutely decompensated heart failure in emergency departments.

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Effect of sublingual nitroglycerin in emergency treatment of severe pulmonary edema

Cited by 87 publications

References 13 publications

The Role of Thermal Stress on CHF Admissions in a Tropical Climate

The Role of Thermal Stress on CHF Admissions in a Tropical Climate

Clevidipine for Severe Hypertension in Acute Heart Failure: A VELOCITY Trial Analysis

Management of Acute Decompensated Heart Failure in the Emergency Department

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