Effects of nitroglycerin on left ventricular cavitary size and cardiac performance determined by ultrasound in man

DeMaria, Anthony N.; Vismara, Louis A.; Auditore, Karen J.; Amsterdam, Ezra A.; Zelis, Robert; Mason, Dean T.

doi:10.1016/0002-9343(74)90849-3

Cited by 103 publications

(26 citation statements)

References 43 publications

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“…It is likely therefore that inhaled ISDN may provide more rapid and sustained relief of angina than sublingual GTN. Although the mechanism by which nitrates relax smooth muscle remains unclear their haemodynamic effects are well known (Mason & Braunwald, 1965;Horschen et al, 1966;Mason et al, 1971;DeMaria et al, 1974). The changes observed in this study were qualitatively similar following each preparation, being a reduction in pulmonary vascular resistance and left ventricular filling pressure.…”

Section: Discussionsupporting

confidence: 62%

“…The effect of nitrates on systemic vascular resistance is less clear. Nitroglycerin has been reported to reduce forearm vascular resistance (Mason & Braunwald, 1965), and some workers have demonstrated a reduction in total systemic vascular resistance (Brachfeld et al, 1959), while others have not (DeMaria et al, 1974;Brachfeld et al, 1959;Armstrong et al, 1980). In the present study a small reduction in systemic vascular resistance was observed in each group; this initial reduction was followed by a further rise and fall in patients given sublingual nitroglycerin and inhaled ISDN.…”

Section: Discussionsupporting

confidence: 43%

“…There is general agreement that nitrates reduce pulmonary vascular resistance and dilate systemic veins, thereby reducing left ventricular filling pressure (Mason & Braunwald, 1965;Horschen et al, 1966;Mason et al, 1971;DeMaria et al, 1974;Brachfeld etal., 1959). The effect of nitrates on systemic vascular resistance is less clear.…”

Section: Discussionmentioning

confidence: 99%

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Haemodynamics and plasma concentrations following sublingual GTN and intravenous, or inhaled, isosorbide dinitrate.

Culling¹,

Singh²,

Bashir³

et al. 1984

Brit J Clinical Pharma

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CF44XN1 We measured plasma nitrate levels and haemodynamics following sublingual glyceryl trinitrate (GTN) (0.5 mg), or isosorbide dinitrate (ISDN) administered intravenously (0.5 mg) or by inhalation (1.25 mg) in 23 patients undergoing cardiac catheterisation for investigation of chest pain. 2 Peak levels were detected at 90 s and 5 min following intravenous and inhaled ISDN respectively and at 3 min following sublingual GTN. 3 Intravenous and inhaled ISDN produced similar plasma levels at 30 s and both were significantly greater than following sublingual GTN. 4 Plasma levels were maintained for longer following inhaled ISDN than intravenous ISDN or sublingual GTN. 5 Haemodynamic responses were qualitatively similar following each treatment; reduction in pulmonary vascular resistance and pressure and left ventricular end diastolic pressure occurred in each group. Heart rate, cardiac output and LV dP/dt.P-1 remained unchanged. 6 Maximal haemodynamic responses were greater following ISDN than GTN, with little difference between the two preparations of ISDN. 7 Haemodynamic responses were more sustained following inhaled ISDN than following sublingual GTN or intravenous ISDN, the latter two being similar in this respect. 8 These findings suggest that inhaled ISDN may provide more rapid and sustained relief from angina than sublingual GTN.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionsupporting

confidence: 43%

See 1 more Smart Citation

Haemodynamics and plasma concentrations following sublingual GTN and intravenous, or inhaled, isosorbide dinitrate.

Culling¹,

Singh²,

Bashir³

et al. 1984

Brit J Clinical Pharma

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“…With respect to preload, a similar trend was seen. These data obtained in healthy subjects should be well applicable also to patients having coronary artery disease without heart failure, since the basic actions of nitroglycerin do not differ between these populations (DeMaria et al, 1974).…”

Section: Discussionmentioning

confidence: 80%

Does alcohol intensify the hemodynamic effects of nitroglycerin?

Kupari

Heikkilä

Ylikahri

1984

Clinical Cardiology

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Summary: To evaluate the combined effects of alcohol and nitroglycerin on cardiovascular hemodynamics, Mmode echocardiography and sphygmomanometric blood pressure measurements were perfonned on two groups of nonnal subjects, before and after the administration of nitroglycerin, both in the sober state and during alcohol intoxication. In the first part of the study, 0.5 mg of nitroglycerin was given sublingually to 10 healthy volunteers 5-10 minutes after they had ingested I g/kg body weight of ethanol within a 30-minute period. Control experiments substituted juice for ethanol. The combined effects of ethanol and nitroglycerin on left ventricular diameters, systolic blood pressure, and wall stress were not significantly different from those of juice and nitroglycerin; heart rate and diastolic blood pressure were increased more (p

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“…NTG spray delayed the onset of 1 mm of ST depression in 14 patients. On the average, ST-segment depression appeared between the third and fourth minutes of control exercise (mean 3.6 ± 1.3 minutes, median 3.7 minutes) and between the fifth and sixth minutes (mean 5.6 ± 1.8 minutes, median 6.1 minutes) of exercise after NTG spray (p < 0.001).…”

Section: St-segment Depression At Maximal Exercisementioning

confidence: 87%

Increased exercise tolerance after nitroglycerin oral spray: a new and effective therapeutic modality in angina pectoris.

Kimchi¹,

Lee²,

Amsterdam³

et al. 1983

Circulation

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22. Maroko PR, Radvany P, Braunwald E, Hale SL: Reduction of infarct size by oxygen inhalation following acute coronary occlusion. mill exercise testing. Our initial experience with NTG spray has been presented in preliminary form.8 Methods PatientsTwenty patients (17 males and three females), mean age 61 years (range 50-74 years), with stable, exercise-induced angina pectoris participated in this trial. Their history of angina ranged from 6 months to 12 years (average 44 months). All patients had angiographically demonstrable coronary artery disease, and had at least 70% narrowing of luminal diameter in at least one major coronary artery. Ten patients had had a myocardial infarction at least 6 months before the study. Five patients had undergone coronary artery bypass graft surgery but continued to have stable angina. None of the patients were hypertensive or had clinical or radiologic evidence of heart failure. All patients had undergone treadmill exercise testing within 6 months before the study; treadmill exercise-induced angina and ischemic ST depression of 1.0 mm or more lasting at least 0.08 second occurred in each patient. All In the sitting position 1 minute after NTG spray, there was no significant change in heart rate compared with control. However, 2 minutes after administration of NTG spray in the standing position, mean heart rate increased significantly (p < 0.01). Placebo spray did not increase heart rate either in the sitting or standing position. Systolic blood pressure declined significantly after NTG spray in the sitting and standing positions (p < 0.001). Placebo spray had no significant effect on systolic blood pressure in the standing position.Effect on Exercise-induced Angina and Exercise Tolerance NTG spray relieved symptoms in all 20 patients. The onset of angina was delayed by a mean of 100 ± 64 seconds (p < 0.001) in 13 patients and pain was totally prevented in seven patients. Placebo delayed the onset of angina in 11 patients, but the magnitude of the delay was not significant (17 + 39 seconds); placebo prevented angina in only one patient.Exercise tolerance as assessed by maximal exercise duration improved significantly after NTG. NTG spray extended exercise duration 31%, from 321 + 97 to 420 + 111 seconds (p < 0.001). In contrast, there was no significant alteration after placebo compared with control (300 ± 97 vs 312 + 97 seconds).Estimated maximal total body oxygen consumption (VO2 max) at peak exercise increased from 24.1 + 3.8 to 27.6 ± 4.9 ml/kg/min (p < 0.001) after NTG spray, but did not significantly change after placebo (22.9 + 3.7 to 23.4 + 3.8 ml/kg/min). Hemodynamic Data at Maximal ExerciseMaximal heart rate increased in all patients after *Chest pain scale: 0 = no pain; 1 + = mild pain; 2 + = moderate pain; 3 + = moderately severe pain (or equivalent to that which usually necessitated discontinuation of activity); 4 + = very severe pain equivalent to the most severe pain the patient had experienced. Measurements in the sitting position were taken 1 minute after ad...

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Effects of nitroglycerin on left ventricular cavitary size and cardiac performance determined by ultrasound in man

Cited by 103 publications

References 43 publications

Haemodynamics and plasma concentrations following sublingual GTN and intravenous, or inhaled, isosorbide dinitrate.

Haemodynamics and plasma concentrations following sublingual GTN and intravenous, or inhaled, isosorbide dinitrate.

Does alcohol intensify the hemodynamic effects of nitroglycerin?

Increased exercise tolerance after nitroglycerin oral spray: a new and effective therapeutic modality in angina pectoris.

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