Nitrate therapy for left ventricular failure complicating acute myocardial infarction: a haemodynamic comparison of intravenous, buccal, and transdermal delivery systems.

Journal of Cardiovascular Pharmacology
S P VermaS H Taylor

Abstract

The haemodynamic effects of three different methods of nitrate administration [intravenous (i.v.) isosorbide dinitrate (ISDN) and buccal and transdermal nitroglycerin (NTG)] were evaluated in 36 patients with acute left ventricular failure due to a recent myocardial infarction. Similar reductions in pulmonary artery occluded pressure (p less than 0.01) followed all three regimens without change in heart rate and cardiac and stroke volume indices. Significant reductions in systemic arterial pressure and vascular resistance followed both ISDN and buccal NTG but not transdermal NTG. A disadvantage of the buccal NTG delivery was an abrupt and, on occasion, inappropriate reduction in blood pressure. The more gradual and controlled reduction of systemic blood pressure with substantial falls in pulmonary artery occluded pressure following ISDN infusion suggest that in the context of myocardial infarction this method of nitrate delivery may have safety advantages; however, when invasive haemodynamic monitoring facilities are not available, transdermal delivery may offer a practical alternative.

Citations

Jan 1, 1993·Postgraduate Medical Journal·K S Channer
Nov 11, 1989·Lancet
May 24, 2011·The Canadian Journal of Cardiology·Jonathan G Howlett
Jul 17, 2008·The Canadian Journal of Cardiology·Jonathan G Howlett
Mar 1, 1993·JPEN. Journal of Parenteral and Enteral Nutrition·M A McFaddenD F Kirby

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