Effect of Isosorbide Dinitrate on Hemodynamics and Respiration of Patients with Coronary Artery Disease and of Patients with Chronic Cor pulmonale

Konietzko, N.; Schlehe, H; Harich, Benjamin; Matthys, H

doi:10.1159/000193667

Cited by 36 publications

(7 citation statements)

References 12 publications

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“…The effects of nitroglycerin on the systemic circulation are well known, and as regards pulmonary circulation, the decreased PAP observed during intravenous administration of nitroglycerin in two recent studies [5,6]. This may have been due to a concomitant decrease of cardiac output [22] and PVR [23]. In the present study, we used a nitroglycerin dose of 1 and 2.5 Ìg/kg/min.…”

Section: Discussionmentioning

confidence: 92%

Effects of Inhalation of Nitroglycerin on Hypoxic Pulmonary Vasoconstriction

Bando

Ishii²,

Kitamura³

et al. 1998

Respiration

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Recent studies suggest that nitric oxide (NO) may play an important role in the pathophysiology of pulmonary hypertension. Nitroglycerin is metabolized to NO, which is a potent vascular smooth muscle relaxant. The aim of the present study was to compare the effects of inhaled and infused nitroglycerin on pulmonary hemodynamics and gas exchange in anesthetized, artificially ventilated dogs. Nitroglycerin was administrated either by inhalation or by infusion. Systemic blood pressure (SBP), pulmonary arterial pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured, and cardiac output was estimated by an electromagnetic flowmeter. Blood gas measurements were performed during hypoxic gas exposure (FiO₂; 0.1) with a continuous inhalation or infusion of nitroglycerin (1, 2.5 µg/kg/min). Inhaled (n = 4) and infused (n = 4) nitroglycerin (1 µg/kg/min) did not produce any detectable effects on the hemodynamics. Inhaled nitroglycerin (2.5 µg/kg/min) reduced SBP, PAP and calculated pulmonary vascular resistance (PVR) in all dogs. Cardiac output did not change. In addition, inhaled nitroglycerin increased PaO₂. In contrast, the continuous infusion of nitroglycerin (2.5 µg/kg/min) did not change in PAP, whereas infused nitroglycerin decreased the mean SBP. Infused nitroglycerin did not alter cardiac output and calculated PVR. A decreased PaO₂ was noted in 2 dogs on nitroglycerin infusion. These findings indicate that inhaled nitroglycerin effects the pulmonary circulation relatively more than infused nitroglycerin, which tends to have more of a general effect on the systemic circulation. The effects of inhaled nitroglycerin may thus be comparable to the effects of NO inhalation.

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Section: Discussionmentioning

confidence: 92%

Effects of Inhalation of Nitroglycerin on Hypoxic Pulmonary Vasoconstriction

Bando

Ishii²,

Kitamura³

et al. 1998

Respiration

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“…In patients with PAH, vasodilator agents generally cause modest reductions in both Ppa and PVR, and an improvement in CO. 76 Vasodilators, such as calcium channel blockers, nitrates, hydralazine, and angiotensin-converting enzyme inhibitors, produce modest, short-term hemodynamic benefits in cor pulmonale secondary to COPD; these effects are generally not sustained with long-term therapy. [77][78][79][80][81] Phlebotomy Mean Ppa and PVR decrease in polycythemic patients who undergo phlebotomy. 82 The reduction of markedly elevated hematocrit level to about 50% improves hemodynamic indices both at rest and during exercise.…”

Section: Vasodilatorsmentioning

confidence: 99%

Pulmonary Hypertension and Cor Pulmonale in COPD

Lee‐Chiong

Matthay²

2003

Seminars in Respiratory and Critical Care Medicine

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Pulmonary artery hypertension (PAH) is the primary cardiovascular complication encountered in chronic obstructive pulmonary disease (COPD). Cor pulmonale can range clinically from mild changes in right ventricular function to frank right heart failure. The prevalence of PAH increases as COPD worsens, and the development of PAH and cor pulmonale appears to affect survival of patients with COPD. Potential causes proposed to explain the development of PAH in COPD include gas exchange abnormalities, destruction of the pulmonary vascular bed, alterations in respiratory mechanics, changes in intrinsic pulmonary vessel tone, and increased blood viscosity. Standard clinical evaluation, including history, physical examination, spirometry, electrocardiography, and chest radiography, is generally inadequate in identifying right ventricular dysfunction. Noninvasive techniques, such as echocardiography, radionuclide ventriculography, and magnetic resonance imaging, have largely replaced invasive pulmonary artery catheterization in the initial assessment of cor pulmonale. The goals of therapy consist of attenuation of PAH, enhancement of right ventricular function, alleviation of clinical symptoms, and improvement in survival. The agents that have been most extensively evaluated for these purposes include oxygen, vasodilators, theophylline, and inotropic medications.

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“…'~.~~ In addition it has been shown to reduce pulmonary vascular resistance when given to patients in whom this is elevated. 73 Since an intravenous preparation of this agent is now available it may prove to be useful in some patients after heart surgery.…”

Section: Choice Of Vasodilatormentioning

confidence: 99%

“…Downes et a1.' 73 to provide a safe, controlled method of weaning patients from mechanical ventilators by allowing spontaneous respiration to account for a progressively larger proportion of the minute volume. Some authorities feel that this technique may be successful when other methods have failed,'14 although others168 have not been able to substantiate this claim.…”

Section: Imv and M M V Imv Was Introduced Bymentioning

confidence: 99%

Current management of patients after cardiopulmonary bypass

Hinds

1982

Anaesthesia

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SummaryThe postoperative management of cardiac surgical patients is reviewed with particular rqference to some of the recent advances and current controversies. i t is emphasised that there has been CI marked decrease in the incidence of many qf the mujor problems associated M.ith car~iiopulmonary bypass and that, in the majority of cases, cardiac surgery is now N routine procvdure associated with a very 1 0~1 morbidity und rnor tdity .

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Effect of Isosorbide Dinitrate on Hemodynamics and Respiration of Patients with Coronary Artery Disease and of Patients with Chronic Cor pulmonale

Cited by 36 publications

References 12 publications

Effects of Inhalation of Nitroglycerin on Hypoxic Pulmonary Vasoconstriction

Effects of Inhalation of Nitroglycerin on Hypoxic Pulmonary Vasoconstriction

Pulmonary Hypertension and Cor Pulmonale in COPD

Current management of patients after cardiopulmonary bypass

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