Paradoxical Action of Glyceryl Trinitrate (Nitroglycerin) in Coronary Patients

Russek, Henry I.

doi:10.1001/jama.1955.02960120017006

Cited by 43 publications

(9 citation statements)

References 13 publications

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“…Under these conditions the direct myocardial effect of nitroglycerin on the canine heart was to actually divert flow away from the vulnerable subendocardium. This observation may help to explain the paradoxical clinical observation that electrocardiographic evidence of subendocardial ischemia may occasionally be induced by the administration of nitroglycerin (21). We conclude that it is unlikely that the action of nitroglycerin to avert or relieve the pain of angina pectoris is through selective dilation of the deep coronary vessels.…”

Section: Figurementioning

confidence: 71%

Nitroglycerin and Heterogeneity of Myocardial Blood Flow REDUCED SUBENDOCARDIAL BLOOD FLOW AND VENTRICULAR CONTRACTILE FORCE

Forman¹,

Kirk²,

Downey³

et al. 1973

J. Clin. Invest.

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AB STRA C T The effects of both intracoronary and intravenous administration of nitroglycerin on transmural distribution of blood flow in the left ventricle after partial coronary artery occlusion was investigated using two independent methods. In 16 open chest, anesthetized dogs, tubing supplying the cannulated left coronary artery was partially occluded. Strain gauges sutured parallel to superficial and deep fibers of the myocardium separately recorded the contractile force of each layer. With occlusion set so that depression of the deep contractile force was imminent, 12 Ag intracoronary nitroglycerin in seven dogs depressed only the deep contractile force without changing systemic hemodynamics. Intravenous administration of 180 Ag nitroglycerin in nine dogs resulted in a decrease of deep contractile force and aortic pressure often associated with an increase in superficial contractile force. Distribution of myocardial blood flow during peak coronary flow after intracoronary administration of nitroglycerin or during a decrease in aortic pressure after intravenous nitroglycerin administration was determined by the tissue uptake of an intracoronary bolus of rubidium-8. This was compared with the uptake of potassium-'2 injected before nitroglycerin. Intravenous or intracoronary administration of nitroglycerin caused a significant reduction in subendocardial blood flow with a decrease in the subendocardial/subepicardial ratio of isotope.

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Section: Figurementioning

confidence: 71%

Nitroglycerin and Heterogeneity of Myocardial Blood Flow REDUCED SUBENDOCARDIAL BLOOD FLOW AND VENTRICULAR CONTRACTILE FORCE

Forman¹,

Kirk²,

Downey³

et al. 1973

J. Clin. Invest.

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“…Previous reports have indicated a variable effect of nitroglycerin on coronary flow, ventricular work, and myocardial efficiency in man and in experimental animals (Cameron, 1911;Katz et al, 1938;Essex et al, 1940;Wegria et al, 1951;Brandt, Caccese, and Dock, 1952;Eldridge et al, 1955;Muller and R0rvik, 1958;Sarnoff, Case, and Macruz, 1958b;Brachfeld, Bozer, and Gorlin, 1959;Gorlin et al, 1959;Russek, Urbach, and Zohman, 1955;Gregg, 1950;Case and Roven, 1963;Johnson, Fairley, and Carter, 1959;Honig, Tenney, and Gabel, 1960;Bergamaschi and Glasser, 1963). Discrepancies are due, in part, to the fact that this drug affects cardiovascular function in a rapid manner and, therefore, measurements of the various parameters need to be performed at very frequent intervals.…”

Section: Discussionmentioning

confidence: 96%

Effect of nitroglycerin on cardiovascular function at fixed and at variable heart rate.

Benchimol¹,

Liggett²,

Duenas³

et al. 1965

Heart

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This work was undertaken in order to study the effect of nitroglycerin on (a) the cardiac functions in patients with a fixed ventricular rate due to complete heart block and in patients with normal sinus rhythm, and (b) the contribution of atrial systole to ventricular filling at a fixed ventricular rate. SUBJECTS AND METHODSStudies were carried out on 23 patients divided into 2 groups: Group 1. 14 consecutive patients with complete heart block were studied, whose ages ranged from 55 to 76 with a group average of 70-2 years. Aetiology of the heart block in 8 patients was considered to be coronary artery disease, as judged by clinical and laboratory evidence. In 6, all of whom developed block past age 50, no probable oetiology could be assigned. Of the 14 patients, 8 had the wires of a fixed rate permanent pacemaker (Chardack-Greatbatch) implanted in the free wall of the left ventricle; in the remaining 6 the heart was stimulated by means of a bipolar electrode catheter placed in the right ventricle and connected to an external pacemakert (Model TR-3).Group 2. 9 patients with normal sinus rhythm were studied: 4 had coronary disease, 1 had essential hypertension, and 4 had no evidence of heart disease. Their ages ranged from 45 to 72 years with a group average of 60 years.Cardiac output was determined with the indicator-dilution technique using indocyaninet (Cardiogreen) as an indicator. Details of this technique were described in a previous report . The indicator was rapidly injected into the left cubital vein with sampling from the brachial artery through a No. 18 Cournand needle. A Gilford cuvette densitometer § (Model 103 IR) was used to detect the injected dye. The curves were recorded in the Electronics for Medicine oscilloscopic photographic recorder** (Model DR-8) at a paper speed of 5 mm./sec. The cardiac output was calculated with the Stewart-Hamilton method in 14 patients. In the remaining 9 the output of the densitometer was coupled with a dye-dilution Note: Tables giving the full clinical details and results of haemodynamic studies have been prepared by the authors. They are not published here, but workers wishing for such information should apply directly to Dr. Alberto

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“…8 Recently, discrete narrowing of the coronary arteries induced by glyceryl trinitrate has been shown angiographically in three patients.56 of these, one experienced chest pain associated with ST segment elevation,6 but the others did not. 5 In our patients unusual vasomotor responses were observed after glyceryl trinitrate had been given to relieve the coronary artery spasm induced by ergonovine maleate.…”

Section: Discussionmentioning

confidence: 99%

Unusual vasomotor coronary arterial responses after reversal of ergonovine induced spasm with glyceryl trinitrate.

Hattori¹,

Takatsu²,

Yui³

et al. 1984

Heart

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SUMMARY Unusual vasomotor responses in the coronary arteries occurred in two patients after the administration of glyceryl trinitrate to relieve spasm induced by ergonovine maleate. In one patient after treatment with glyceryl trinitrate and despite dilatation of the adjoining segments a new severe reduction in diameter occurred distally to the segments of the right coronary artery where the ergonovine induced spasm developed. In the other patient the left anterior descending artery filled very slowly after the completely occlusive spasm of the right coronary artery had resolved with glyceryl trinitrate though the circumflex did not. These vasomotor changes were associated with chest discomfort and electrocardiographic abnormalities in both cases.These findings indicate that caution is needed when performing provocative tests even after the ergonovine induced spasm has been reversed with glyceryl trinitrate.The ergonovine maleate test has been widely used and accepted as a sensitive and specific technique for detecting coronary arterial spasm. Cardiac catheterisation performed without premedication showed normal resting haemodynamic measurements. Selective coronary arteriography was carried out by the Sones method. The right (Fig la) and left coronary arteriograms were normal, Ergonovine maleate 0.2 mg given intravenously did not precipitate symptoms or ST segments shifts, but sequential narrowing (Fig. lb) was evident in the proximal segments of the right coronary artery on the repeat arteriogram. Glyceryl trinitrate 03 mg was given sublingually and the left coronary artery visualised in multiple projections. Immediately before the injection of the right coronary artery the patient complained of chest pain, and there was slight elevation of the ST segment in lead II. The right coronary arteriogram performed immediately showed a new 900/o reduction in diameter in the mid-portion (Fig. lc). The adjoining segments were dilated. During the next three minutes the chest pain abated without specific treatment, and the ST segment elevation resolved. CASE 2A 64 year old man had noticed discomfort in the precordium at rest and during ordinary activity in the early morning for nine months before admission. This symptom became more severe and also occurred at 312 on 7 June 2019 by guest. Protected by copyright.

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Paradoxical Action of Glyceryl Trinitrate (Nitroglycerin) in Coronary Patients

Cited by 43 publications

References 13 publications

Nitroglycerin and Heterogeneity of Myocardial Blood Flow REDUCED SUBENDOCARDIAL BLOOD FLOW AND VENTRICULAR CONTRACTILE FORCE

Nitroglycerin and Heterogeneity of Myocardial Blood Flow REDUCED SUBENDOCARDIAL BLOOD FLOW AND VENTRICULAR CONTRACTILE FORCE

Effect of nitroglycerin on cardiovascular function at fixed and at variable heart rate.

Unusual vasomotor coronary arterial responses after reversal of ergonovine induced spasm with glyceryl trinitrate.

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