Document Detail

Intravenous nitroglycerin unloading in acute myocardial infarction.
MedLine Citation:
PMID:  1836097     Owner:  NLM     Status:  MEDLINE    
Low-dose intravenous nitroglycerin infusion can be safely administered during acute myocardial infarction to unload the left ventricle and salvage ischemic myocardium and left ventricular geometry and function. In an experimental conscious dog model, low-dose infusion titrated to decrease mean blood pressure by 10% over the first 6 hours after coronary artery ligation resulted in 51% decrease in infarct size, 54% decrease in preload, and more than 50% increase in collateral blood flow. The same benefits were seen when methoxamine was given to counteract that 10% decrease in blood pressure. Similar short-term nitroglycerin infusion also limited remodeling in the dog model. More important, no myocardial salvage was seen with excessive nitroglycerin-induced hypotension to levels less than 80 mm Hg. Clinically, prolonged low-dose nitroglycerin infusion was evaluated in a prospective, randomized, single-blinded, placebo-controlled study of 310 patients with acute infarction: 154 received nitroglycerin and 156 received placebo. Nitroglycerin was titrated to reduce mean blood pressure by 10% in normotensive patients and up to 30% in hypertensive (blood pressure greater than 140/90 mm Hg) patients, but not to less than 80 mm Hg. Nitroglycerin produced several benefits compared with placebo: (1) smaller creatine kinase infarct size; (2) less regional left ventricular dysfunction, better global ejection fraction, and less infarct expansion and thinning; (3) better clinical functional status and hemodynamics; (4) fewer inhospital complications such as acute left ventricular failure and dilation due to marked infarct expansion, left ventricular thrombus, cardiogenic shock, and infarct extension; and (5) fewer deaths up to 1 year in patients with anterior Q-wave infarction.
B I Jugdutt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The American journal of cardiology     Volume:  68     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1991 Nov 
Date Detail:
Created Date:  1992-01-16     Completed Date:  1992-01-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  52D-63D     Citation Subset:  AIM; IM    
Department of Medicine, University of Alberta, Edmonton, Canada.
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MeSH Terms
Cardiomegaly / prevention & control
Heart / drug effects
Infusions, Intravenous
Myocardial Infarction / drug therapy*
Nitroglycerin / administration & dosage,  therapeutic use*
Ventricular Function, Left / drug effects
Reg. No./Substance:

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