Wirkung von Nitroglycerin sublingual in der Notfalltherapie des klassischen Lungenödems

Abstract

Of 22 patients with the classical clinical signs of pulmonary oedema (orthopnoe, cyanosis, sweating and rales heard at a distance) 15 (Group A) were observed clinically, while seven (Group B) underwent haemodynamic studies. Those in Group A were given 0.8-2.4 mg nitroglycerin sublingually one to six times at 5--10 minute intervals. Within five minutes of nitroglycerin administration 7 of the 15 had their first signs of clinical improvement. In 11 patients the rales had disappeared after 15--20 minutes or had regressed. In the remainder the dyspnoea had decreased so that at this point in 14 of the 15 patients various degrees of improvement had occurred. Four patients were completely without clinical signs after 30 minutes. The increased arterial blood pressure and heart rate had fallen markedly. In the seven patients of Group B mean left ventricular filling pressure fell within ten minutes of nitroglycerin administration (1.6 mg) from 33 +/- 10 to 24 +/- 8 mmHg, cardiac output rising sifnificantly from 3.3 +/- 0.8 to 3.7 +/- 0.8 1/min. Such favourable results with nitroglycerin are to be expected only if the pulmonary oedema is of cardiac origin.

Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension

“…In contrast, a positive influence on the cardiac effects should be expected with administration of nitroglycerin. Thus nitroglycerin exhibits a clearly antianginal and antiischemic effect and should exert the same favorable effect on acute left ventricular failure because of the strong venous pooling effect [3,9]. However, it is unclear, whether the antihypertensive effect is sufficient compared with that of nifedipine, and whether the effect persists long enough.…”

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

“…Our present results indicate that continuous infusion of nitroglycerin over a period of 2 d has beneficial effects on hemodynamics in patients with recent myocardial infarction (Armstrong et al, 1975;Bussmann, 1975;Bussmann and Kaltenbach, 1975;Bussmann and Schupp, 1977;Bussmann et al, 1974aBussmann et al, ,b, 1975aBussmann et al, ,b,c, 1976aBussmann et al, ,b, 1977Chatterjee et al, 1976;Come et al, 1975;Cyran et al, 1978;Flaherty et al, 1975Flaherty et al, , 1976Gold el al., 1972;Kotter et al, 1980;Mikulic et al, 1975;Williams et al, 1975). In patients with and without left ventricular failure the decrease in left ventricular filling pressure was significant when compared to the untreated control group.…”

“…There was a slight increase in heart rate in treated patients but nochanges in untreated controls. left ventricular failure (Bussmann and Schupp, 1977;Bussmann et al, 1976b).…”

Zur kardialen und vaskulären Wirkung von Furosemid

“…Die hämodynamischen Veränderungen führten insgesamt zu einer Abnahme des myokardialen Sauerstoffverbrauchs 6,20/o; P < 0,01). In zusätzlichen Untersuchungen während »Steady-state«-Bedingungen der extrakorporalen Zirkulation (n 10) konnte gezeigt werden, daß es nach Gabe von Furosemid als Ausdruck einer venendilatatorischen Wirkung zu einem signifikanten Abfall des Blutspiegels im Oxygenator der Herz-Lungen-Maschine kommt. Auf der arteriellen Seite ließ sich ein leichter Anstieg des Perfusionsdrucks feststellen, der jedoch nicht statistisch von der Kontrollgruppe verschieden war.…”