The haemodynamic effects of sublingual nitroglycerin spray in severe left ventricular failure

Edwards, Joseph; Grant, P. T.; Plunkett, Patrick K.

doi:10.1007/bf00271060

“…No other group of agents improves the symptoms of congestion as rapidly as nitrates. Treatment with sublingual nitroglycerin (tablets or spray) results in noticeable hemodynamic and clinical improvement within 5 minutes 51– 53 . Single doses of 0.4‐0.6 mg can be given repeatedly every 5–10 minutes if the patient has stable blood pressure.…”

Section: Pharmacologic Therapymentioning

confidence: 99%

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

Kosowsky

¹

,

Abraham

²

,

Storrow

³

2001

Congestive Heart Failure

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Symptoms of acutely decompensated heart failure commonly cause patients to seek care in the emergency department (ED). Decompensated heart failure can arise de novo-for example, in the setting of acute myocardial infarction (MI). More commonly, however, symptomatic heart failure presents in the context of pre-existing left ventricular dysfunction. An underlying diagnosis of chronic heart failure having already been established, one or more precipitating factors lead to clinical decompensation.Acutely decompensated chronic heart failure is a poorly defined clinical entity, and no universal definition exists. 1 Chronic heart failure is itself a complex and multifaceted clinical syndrome, encompassing conditions of both systolic and diastolic dysfunction. An acute decompensation can manifest over a period of minutes, hours, or days and can range in severity from mild symptoms of volume overload or decreased cardiac output to frank pulmonary edema or cardiogenic shock.However defined, the number of patients who present to the ED with decompensated chronic heart failure is likely to increase over the coming years. With the aging of the United States' population, the overall prevalence of heart failure is rising. 2 At the same time, advances in outpatient therapy are allowing patients with chronic heart failure to live longer with more advanced stages of hemodynamic compromise. Nearly five million Americans with heart failure are alive today, and approximately 550,000 new cases arise each year. Heart failure now accounts for close to one million inpatient admissions annually, is a secondary diagnosis associated with another two million hospitalizations each year, and represents the number one reason for hospital admission among the growing elderly population. 3 Short-term outcomes for patients admitted with decompensated heart failure have remained fairly constant over the past two decades. In-hospital mortality remains at approximately 7%, 4,5 with major adverse events occurring in up to 18% of patients. 6 For those who present with frank pulmonary edema, the corresponding rates of morbidity and mortality are approximately doubled. 7-10 Meanwhile, hospital

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“…When administered in an acute myocardial infarction (MI), the nitrates reduce pulmonary congestion, complaints about dyspnea, and arterial blood pressure, and simultaneously increase cardiac output. [2][3][4][5] Consequently, nitrates are widely used for the treatment of MI in forms ranging from sublingual to transdermal and intravenous. [6][7][8] Two large multicenter studies, Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico (GISSI-3) and the Fourth International Study of Infarct Survival (ISIS-4), dealt with the effects of nitrates on mortality following MI.…”

Section: Introductionmentioning

confidence: 99%

Effects of long‐term transdermal nitrate treatment on left ventricular function in patients following myocardial infarction

Király

¹

,

Kiss

²

,

Timár

³

et al. 2003

Clinical Cardiology

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SummaryBackground: Nitrates are widely used for the treatment of myocardial infarction (MI). The large megatrials (GISSI-3 and ISIS-4) did not in fact demonstrate a significant decrease in mortality in the nitrate-treated group. However, examination of the number of postinfarction angina episodes and the occurrence of cardiogenic shock in the GISSI-3 study did reveal significant decreases.Hypothesis: It was hypothesized that chronic nitrate treatment after an MI preserves left ventricular systolic and/or diastolic functions.Methods: Patients were divided into two groups: those receiving chronic nitrate treatment for 6 months after an MI (n = 30), and those without such treatment (n = 29). Echocardiography was performed 3, 14, 42, and 180 days after the infarction. The changes in early diastolic and atrial contractionrelated mitral valve inflow pattern and deceleration time were assayed. Alterations in systolic, diastolic, and atrial reverse flow velocities in the pulmonary vein were measured, as were ejection fraction (EF), the number of registered angina episodes, and the maximal ST-segment depression in response to the stress test.Results: During the 6-month study period, the increase in systolic pulmonary venous flow velocity was significantly larger in the nitrate group than in the controls. The decreases in the velocities of the diastolic and the atrial reverse flow were also more pronounced in the nitrate group than in the controls.

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“…No other group of agents improves the symptoms of congestion as rapidly as nitrates. Treatment with sublingual nitroglycerin (tablets or spray) results in noticeable hemodynamics and clinical improvement within 5 minutes 51–53 . Single doses of 0.4–0.6 mg can be given repeatedly every 5–10 minutes if the patient has stable blood pressure.…”

mentioning

confidence: 99%

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

Kosowsky

¹

,

Abraham

²

,

Storrow

³

2001

Congestive Heart Failure

View full text Add to dashboard Cite

Symptoms of acutely decompensated heart failure commonly cause patients to seek care in the emergency department (ED). Decompensated heart failure can arise de novo-for example, in the setting of acute myocardial infarction (MI). More commonly, however, symptomatic heart failure presents in the context of pre-existing left ventricular dysfunction. An underlying diagnosis of chronic heart failure having already been established, one or more precipitating factors lead to clinical decompensation.Acutely decompensated chronic heart failure is a poorly defined clinical entity, and no universal definition exists. 1 Chronic heart failure is itself a complex and multifaceted clinical syndrome, encompassing conditions of both systolic and diastolic dysfunction. An acute decompensation can manifest over a period of minutes, hours, or days and can range in severity from mild symptoms of volume overload or decreased cardiac output to frank pulmonary edema or cardiogenic shock.However defined, the number of patients who present to the ED with decompensated chronic heart failure is likely to increase over the coming years. With the aging of the United States' population, the overall prevalence of heart failure is rising. 2 At the same time, advances in outpatient therapy are allowing patients with chronic heart failure to live longer with more advanced stages of hemodynamic compromise. Nearly five million Americans with heart failure are alive today, and approximately 550,000 new cases arise each year. Heart failure now accounts for close to one million inpatient admissions annually, is a secondary diagnosis associated with another two million hospitalizations each year, and represents the number one reason for hospital admission among the growing elderly population. 3 Short-term outcomes for patients admitted with decompensated heart failure have remained fairly constant over the past two decades. In-hospital mortality remains at approximately 7%, 4,5 with major adverse events occurring in up to 18% of patients. 6 For those who present with frank pulmonary edema, the corresponding rates of morbidity and mortality are approximately doubled. 7-10 Meanwhile, hospital

show abstract

The haemodynamic effects of sublingual nitroglycerin spray in severe left ventricular failure

Cited by 3 publications

References 14 publications

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

Effects of long‐term transdermal nitrate treatment on left ventricular function in patients following myocardial infarction

Evaluation and Management of Acutely Decompensated Chronic Heart Failure in the Emergency Department

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