HARMFUL EFFECTS OF NITROGLYCERIN. With Special Reference to Coronary Thrombosis

Prodger, Samuel H.; Ayman, David

doi:10.1097/00000441-193210000-00005

Cited by 52 publications

(7 citation statements)

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“…Sudden profound hypotension, however, has been infre quently reported (14,15,(18)(19)(20)(21) and is certainly less common than with sodi um nitroprusside or congeners (25). Hemodynamic studies suggest that NTG may lower blood pressure by a predominant venodilator effect and quantitative ly lesser effect on arteriolar resistance vessels (26).…”

Section: Discussionmentioning

confidence: 99%

“…Noer (18) reported a patient with clinical shock associated with 'a very slow and irregular pulse' following NTG administration, and Sprague and White (20) reported similar findings in 2 patients with unstable angina. Prodger and A y man (19) carefully recorded 4 case reports documenting the bradycardia-hypotension syndrome following administration of 0.4-1.3 mg sublingual NTG. In 1 patient without a history of hypertension, angina, or previous infarction, sinus bradycar dia progressing to third-degree AV block was documented electrocardiographicaily.…”

Section: Discussionmentioning

confidence: 99%

“…Occasional reports in the literature, however, suggest that some cases of idiosyncratic NTG-induced hypotension may be related to effects on pacemaker or conduction tissue rather than, or in addition to, effects on vasomotor tone. Severe bradycardia associated with systemic arterial hypotension has been docu mented as a complication of sublingual NTG administration in 9 patients to date, only 4 of whom had electrocardiographic monitoring during the hypoten sive phase (18)(19)(20)(21). We report here 3 patients seen recently in whom NTG produced severe bradycardia and hypotension.…”

Section: Introductionmentioning

confidence: 91%

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Syndrome of Severe Bradycardia and Hypotension following Sublingual Nitroglycerin Administration

Nemerovski

Shah²

1981

Cardiology

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Severe bradycardia associated with profound systemic arterial hypotension was observed in 3 patients following sublingual nitroglycerin administration. All patients had clinical evidence of active ischemic heart disease. In 1 patient, third-degree heart block was observed several hours later, requiring pacemaker therapy. Radionuclide ventriculography in 1 patient during the bradycardia revealed no significant change in regional wall motion or in left or right ventricular ejection fraction. Review of the literature shows no consistent predictors as to which patients are at risk for developing this syndrome. Possible pathophysiologic mechanisms are discussed. These case reports illustrate an unpredictable and serious complication of nitroglycerin administration, and emphasize the need for caution in use of this drug for ischemic heart disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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Syndrome of Severe Bradycardia and Hypotension following Sublingual Nitroglycerin Administration

Nemerovski

Shah²

1981

Cardiology

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“…The study involved 114 patients who were admitted to the Barnes Hospital coronary care unit with suspected acute myocardial infarction. Criteria for entry were: (1) chest pain suspected to be of cardiac origin; (2) electrocardiographic abnormalities suggesting acute myocardial ischaemia or infarction; (3) onset of symptoms within 12 hours of randomisation; (4) systolic blood pressure of 100 mmHg or greater and a heart rate of less than 120 beats/minutes. Patients with cardiogenic shock were excluded because of hypotension.…”

Section: Patient Populationmentioning

confidence: 99%

Reduction of infarct size in patients with inferior infarction with intravenous glyceryl trinitrate. A randomised study.

Jaffe¹,

Geltman

Tiefenbrunn³

et al. 1983

Heart

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Glyceryl trinitrate was previously said to be contraindicated in patients with acute myocardial infarction. Its intravenous administration during acute infarction, however, was associated with a beneficial effect as determined by ST segment mapping. Most recently in a selected group of patients with acute infarction and abnormal haemodynamics, intravenous glyceryl trinitrate was shown to reduce infarct size estimated by enzymes. The present study was performed to verify the safety of intravenous glyceryl trinitrate in patients with infarction under conventional clinical conditions without invasive monitoring and to determine its effect on infarct size in a prospective randomised trial involving 85 patients with infarction (43 treated and 42 control). Treated patients received glyceryl trinitrate within 10 hours of the onset of symptoms (mean 6.0 hours), and the dose was titrated to preset limits for changes in heart rate and blood pressure. In patients with inferior infarction, infarct size estimated by enzymes in the treated was only 12.2 +/- 1.8 versus 19.1 +/- 3.6 CK gram equivalents per metre squared in the placebo group. A similar but statistically insignificant trend was observed for subendocardial infarction but no difference was observed for anterior infarction. Ventricular arrhythmias determined from 24 hour tapes were more frequent in treated patients though this was not statistically significant. Lignocaine requirements in treated and control (1692 +/- 250 vs 1512 +/- 232 mg/24 h) were similar, as were the requirements for morphine (11.4 +/- 1.8 vs 12.2 +/- 2.2 mg/24 h). Results indicate that intravenous glyceryl trinitrate can be administered safely during evolving infarction without invasive monitoring and reduces infarct size in patients with inferior infarction.

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“…In 1867, Brunton [2] thought that nitrates acted mainly by decreasing blood pressure so that their use in acute MI might not be wise. In 1932, Prodger and Ayman issued warnings about the use of nitrates in acute MI [3]. The 1966 edition of Friedberg's textbook on heart disease [4] reinforced those warnings and further underscored the need to avoid hypotension and reflex tachycardia.…”

Section: Introductionmentioning

confidence: 99%

Use of nitroglycerin for the treatment of acute myocardial infarction

Jugdutt

1994

Heart Vessels

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After a decade of warnings against the use of nitrates in acute myocardial infarction (MI), they are becoming recognized for their potential to salvage left ventricular (LV) myocardium, geometry and function. Low-dose intravenous (IV) nitroglycerin (NTG) infusion for the first 48 h after acute MI, titrated to lower mean blood pressure by 10% to 30%, but not below 80 mmHg, has been shown to be safe, to improve hemodynamics, and to decrease infarct size, infarct expansion, complications, and deaths in a prospective, randomized, single-blind study of 310 patients. In addition, low-dose NTG infusion for the first 48 h, followed by prolonged buccal NTG given during healing after acute MI in an eccentric dose schedule to minimize tolerance, was found to limit further progressive remodeling and preserve LV function. Meta-analysis of nitrate studies in acute MI indicate that they improve survival. Preliminary and ongoing studies suggest that prolonged NTG therapy post MI can produce further benefit.

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HARMFUL EFFECTS OF NITROGLYCERIN. With Special Reference to Coronary Thrombosis

Cited by 52 publications

References 0 publications

Syndrome of Severe Bradycardia and Hypotension following Sublingual Nitroglycerin Administration

Syndrome of Severe Bradycardia and Hypotension following Sublingual Nitroglycerin Administration

Reduction of infarct size in patients with inferior infarction with intravenous glyceryl trinitrate. A randomised study.

Use of nitroglycerin for the treatment of acute myocardial infarction

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