Sustained beneficial effect of a seventy-two hour intravenous infusion of nitroglycerin in patients with severe chronic congestive heart failure

American Heart Journal
J DupuisJ L Rouleau

Abstract

To determine whether a 72-hour infusion of nitroglycerin produces hemodynamic improvement in patients with severe congestive heart failure and to assess the contributing role of various possible causes of hemodynamic tolerance to nitroglycerin, 19 patients received an infusion of nitroglycerin 1.5 micrograms/kg/min for 72 hours. In a subgroup of patients (n = 10), there was an increase in stroke work index and a decrease in ventricular filling pressures throughout the infusion and even after it was discontinued. Tolerance to the hemodynamic effects of nitroglycerin was partially reversed 8 hours after the infusion was stopped. Neurohumoral changes occurred but appeared to play only a minor role in the development of nitroglycerin tolerance. However, hematocrit fell 9 +/- 5%, which suggests that an increased intravascular volume contributed to tolerance. In summary: (1) a 72-hour infusion of nitroglycerin improves ventricular function in some patients with severe heart failure; (2) volume shifts from the extravascular to the intravascular compartments may, at least in part, be responsible for nitroglycerin tolerance; and (3) reflex neurohumoral activation may also play a small role in nitrate tolerance.

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Citations

Jun 1, 1994·Cardiovascular Drugs and Therapy·J Dupuis
Apr 17, 2013·Heart, Lung & Circulation·Konstantin SchwarzMichael P Frenneaux
Jan 1, 1999·Progress in Cardiovascular Diseases·C V Leier, P F Binkley
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Feb 26, 2004·The Annals of Pharmacotherapy·Robert J DiDomenicoGlen T Schumock
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Nov 16, 2001·American Journal of Physiology. Heart and Circulatory Physiology·T D MooreI Belenkie
Nov 4, 2021·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Luis E OkamotoAmy K Wright

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