Hemodynamic effects of nitroglycerin in acute myocardial infarction: Decrease in preload at the expense of cardiac output

Williams, David O.; Otero, Jorge; Lies, James E.; Zelis, Robert; Mason, Dean T.; Amsterdam, Ezra A.

doi:10.1016/0002-9149(74)90978-3

Cited by 49 publications

(31 citation statements)

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“…Vasodilators are generally classified as venodilators acting on preload, arteriolardilators acting on afterload, and mixed agents acting on both sides of the peripheral vascular tree; nitrates are in the first group of agents, which act only on capacitance vessels.3' [9][10][11]26 However, several investigators agree that patients in severe distress who have a low initial CO and markedly increased filling pressure might respond differently. '2' 118, 16, Our data and clinical impression confirm these conclusions.…”

Section: Hemodynamic Profilementioning

confidence: 99%

Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.

Rabinowitz¹,

Tamari²,

Elazar³

et al. 1982

Circulation

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Section: Hemodynamic Profilementioning

confidence: 99%

Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.

Rabinowitz¹,

Tamari²,

Elazar³

et al. 1982

Circulation

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“…Other authors [ 16], too, showed that cardiac output could increase only when pulmonary wedge pressure and systemic vascular resistance were elevated, while it decreased in the pa tients with normal or low values. On the con trary, Williams [17] found a decrease in pul monary wedge pressure, mean arterial pres sure and cardiac output regardless of initial pulmonary wedge pressure value.…”

Section: Discussionmentioning

confidence: 97%

Hemodynamic Mechanisms of the Effect of Nitroglycerin in Patients with Acute Myocardial Infarction

Rezaković¹,

Popadić²,

Popović³

et al. 1991

Cardiology

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We studied the hemodynamic response to intravenous nitroglycerin (NTG) in 40 patients with and without acute heart failure (hemodynamic subsets I-IV) during acute myocardial infarction. Hemodynamic measurements were performed by right heart catheterization. The results showed that NTG response influenced mainly the preload and to a lesser extent the afterload, however these changes were dependent on initial hemodynamic status. The changes in mean arterial pressure and cardiac index were predominantly related to pretreatment pulmonary wedge pressure and slightly to systemic vascular resistance. Response to NTG could be predicted with 85% probability as a decrease of pulmonary wedge pressure, with 58% probability as a decrease in mean arterial pressure and cardiac index, and with 32% probability as an increase in cardiac index and a decrease in systemic vascular resistance. These results indicate that NTG therapy could have optimal results in patients with elevated pulmonary wedge pressure and normal cardiac index, while in the subsets with low mean arterial pressure or low cardiac index potentially deleterious decrease in these values could occur. Therefore the optimal condition for use of intravenous nitroglycerin in the patients with acute heart failure is isolated pulmonary congestion.

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“…This pattern depends largely on the extent of left ventricular failure and the height of left ventricular pressure. Nitroglycerin causes an increase in cardiac output in patients with markedly elevated left ventricular filling pressure ( 2 5 f 4 mmHg, Table III), and a decrease in patients with left ventricularfilling pressure below 20 mmHg (Bussmann et al, 1976b;Come et al, 1975;Flaherty et al, 1975Flaherty et al, , 1976Gold et al, 1972;Kotter et al, 1980;Williams et al, 1975). (9) 24f4 (9) 3 3 f 4 (9) 2 2 f 3 (8) 9 f 4 (8) 4.2f1.0 (7) 3.7f0.9 (8) 48f18 (7) NTG 100f20 (9) 25f4 (9) 3 5 f 9 (9) 2 4 f 4 (8)…”

Section: Discussionmentioning

confidence: 99%

Controlled study of intravenous nitroglycerin treatment for two days in patients with recent myocardial infarction

Bussmann¹,

Barthe²,

Klepzig³

et al. 1980

Clin Cardiol

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Summary: Hemodynamic measurements were obtained for 48 h in 46 patients with recent myocardial infarction. Patients were randomized to treatment with (n = 22) and without nitroglycerin (NTG) (n = 24). In patients with diastolic pulmonary arterial pressure (PAEDP) <20 mmHg (group I), NTG decreased PAEDP from 15 to 1 1 mmHg (n = 13); in the untreated control group PAEDP remained unchanged (n = 15). Cardiac output decreased in the NTG group from 5.4 to 5.0 I/min and in the control group from 4.7 to 4.4 1 /min. Mean arterial pressure decreased in both groups, in the NTG group from 106 to 97 mmHg and in the control group from 102 to 94 mmHg.In patients with left ventricular failure and PAEDP >20 mmHg (group 11) the decrease in left ventricular filling pressure was significantly greater (25 to 17 mmHg, n = 9) than in the control group (24 to 20 mmHg, n = 9). Cardiac output increased during NTG treatment from 4.2 to 5.1 I/min. In the control group, however, cardiac output decreased from 4.2 to 3.6 I/min. Mean arterial pressure decreased from 103 to 95 mmHg in the NTG group and from 114 to 96 mmHg in the control group. Heart rate did not change significantly.Thus, PAEDP decreased significantly in patients who received NTG treatment for 48 h compared to an untreated control group. Cardiac output increased in treated patients, especially those with left ventricular failure, but decreased in the control group. Mean arterial pressure decreased to the same degree in treated patients and in controls.Key words: intravenous nitroglycerin, recent myocardial infarction, long-term effects, increase in cardiac output, decrease in diastolic pulmonary arterial pressure, untreated control group, spontaneous changes

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Hemodynamic effects of nitroglycerin in acute myocardial infarction: Decrease in preload at the expense of cardiac output

Cited by 49 publications

References 0 publications

Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.

Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.

Hemodynamic Mechanisms of the Effect of Nitroglycerin in Patients with Acute Myocardial Infarction

Controlled study of intravenous nitroglycerin treatment for two days in patients with recent myocardial infarction

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