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Cerebral arteriospasm is a common complication of subarachnoid hemorrhage and is responsible for much of the brain damage which accompanies it. No pharmacologic agent has been found which regularly alleviates arteriospasm. We have evaluated the effect of continuous intravenous nitroglycerin infusion on the diameter of the basilar artery in dogs with cerebral vasospasm experimentally induced by subarachnoid blood injection. In 6 consecutive dogs, 10 minutes after beginning intravenous nitroglycerin at 100 microgram/min and at other times during 120 minutes of infusion, the diameter of the basilar artery had increased from 75 +/- 2% of control value to 114 +/- 2% of control value (p less than 0.001). In all 6 dogs, the basilar artery diameter during infusion was greater than the control value prior to creating subarachnoid hemorrhage. Intravenous nitroglycerin caused only a moderate (8%) decrease in blood pressure. Further investigation of the effects of nitroglycerin on cerebral vasospasm is warranted.
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PMID:Intravenous nitroglycerin in experimental cerebral vasospasm. A preliminary report. 10 21

The effects of parenteral nitroglycerin after acute and continuous infusion were investigated in 12 patients with mitral and (or) aortic valvular disease (stage IV of the New York Heart Association) and severe therapy-resistant pulmonary congestion. Intravenous injection of 1 mg led to immediate and marked decrease of right atrial mean pressure, and pulmonary artery and pulmonary capillary mean pressures, whereas mean arterial blood pressure, stroke volume index, cardiac frequency, and cardiac index remained unchanged. With a dosage of 3-10 mg/h the pressure lowering of the right circulation could be sustained. Pressure lowering of the right circulation abolished pulmonary congestion and led to marked reduction of shortness of breath. The principle of venous pooling can thus not only be used successfully in cases of increased pulmonary capillary pressure due to primary myocardial insufficiency, but also in cases with pulmonary congestion due to decompensated valvular disease.
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PMID:[Treatment of decompensated valvular disease with nitroglycerin (author's transl)]. 10 69

It has been shown that hydralazine is beneficial in chronic heart failure by virtue of its afterload reducing effect. Nitroglycerin paste results in venodilation and fall in left ventricular filling pressure (LVFP). Thirteen patients with chronic heart failure were given a combination of oral hydralazine and nitroglycerin paste. With oral hydralazine (75 to 100 mg every 8 h), left ventricular stroke work increased and LVFP slightly fell. Following addition of 2% nitroglycerin paste, an additional decline in mean pulmonary artery and LVFP was observed without significant changes in heart rate and arterial pressure. There were no untoward side effects from either therapy. Eight patients followed for three to eight months (mean five months) reported subjective improvement in shortness of breath and other symptoms related to ventricular dysfunction. This study shows that in certain patients with chronic heart failure, hydralazine and nitroglycerin paste combination produces salutary clinical effects on long term probably through afterload and preload reduction, respectively.
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PMID:Non-parenteral combined afterload and preload reduction therapy in congestive heart failure. 11 91

In acute and chronic left heart failure peripheral resistance is elevated due to increased sympathetic tone. This should compensate the decrease in stroke volume. In the diseased left ventricle however the augmentation of afterload leads to further reduction of stroke volume and to increase of heart size and myocardial oxygen consumption. This vitious cycle may be interrupted by vasodilators. Drugs like nitroglycerin, mainly acting on the venous system, reduce preload and thereby relieve symptoms of pulmonary congestion (backward failure). Phentholamin on the other hand primarily reduces afterload by an action on the resistance vessels and thereby increases cardiac output (forward failure). Nitroprusside has effects on both, the capacity and resistance vessels. So nigroglycerin is the remedy of choice in acute pulmonary edema. Nitroprusside in leftf heart failure in acute myocardial infarction and Phentolamin in acute left ventricular failure due to critical rise in blood pressure. For long term treatment of chronic left heart failure (coronary heart disease, cardiomyopathy, rheumatic heart disease) hydralazin or prazosin may be used as well as long acting nitrates.
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PMID:[Progress in the therapy of acute and chronic cardiac insufficiency by means of systemic vasodilators. Studies with prazosin and nitroglycerin]. 12 80

Thirteen patients with left ventricular failure complicating acute myocardial infarction were treated with intravenous nitroglycerin. The hemodynamic criterium for admission to this study was a pulmonary capillary wedge pressure greater than 15 mm Hg. All patients received intravenous nitroglycerin at infusion rates sufficient to lower pulmonary capillary wedge pressure by an average of 15 mm Hg, corresponding to the optimal left ventricular filling pressure in acute myocardial infarction. During this study, heart rate did not vary significantly; pulmonary capillary wedge pressure decreased from 24 +/- 0,7 to 15 +/- 0,8 mm Hg (p less than 0,001), mean arterial pressure from 95 +/- 5 to 80 +/- 4 mm Hg (p less than 0,005), mean right atrium pressure from 8,7 +/- 1 to 4,6 +/- 0,8 mm Hg (p less than 0,001), systemic vascular resistance index from 36,4 +/- 2 to 29,6 +/- 2 mm Hg/mm-1/l/m2 (p less than 0,005). Cardiac index increased from 2,5 +/- 0,2 to 2,7 +/- 0,1 l/mn/m2 (p less than 0,025) and stroke work index did not vary significantly. These data indicate that nitroglycerin provides a significant improvement of cardiac performance, more through reduction of preload than through reduction of afterload, the later being however significant. This study points out that intravenous nitroglycerin is a most efficient drug in patients with left ventricular failure complicating acute myocardial infarction.
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PMID:[Intravenous nitroglycerin as vasodilator therapy in acute myocardial infarction (author's transl)]. 21 81

Applicability of ultrasonic analogue conversion system devised by us for assessments of left ventricular volume was examined in patients with and without heart disease. The conversion system could sample the echoes from the endocardial surfaces of the interventricular septum and the posterior left ventricular wall. The conversion system could also calculate automatically the minor axis and volume of the left ventricle. End-diastolic, end-systolic, and stroke volumes calculated by the conversion system were close to those calculated from biplane ventriculograms and to those calculated from photographic records of B-mode echo-display. Change in left ventricular volume caused by respiration ranged up to 17.5%. Spontaneous variations in left ventricular volume during continuous monitoring was up to 7.5%. End-diastolic, end-systolic, and stroke volumes were reduced by sublingual administration of nitroglycerin. The results indicate applicability of the ultrasonic analogue conversion system for continuous assessments of left ventricular volume in man.
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PMID:Continuous assessment of left ventricular volume by ultrasonic analogue conversion system. 40 7

The clinical and hemodynamic effects of trinitrin (nitroglycerin) have been studied in 5 patients with long-established coronary artery disease who had been receiving long-term beta blockade therapy (propranolol). 5 similar patients not on propranolol acted as controls. Patients on propranolol reported as effective relief of angina with trinitrin as patients not on this therapy. Although the patients on propranolol had an initially lower systolic blood pressure and mean ventricular rate, sublingual trinitrin caused in both groups a similar fall in aortic pressure, pulmonary wedge pressure, oxygen consumption and stroke volume, together with a similar rise in ventricular rate. It was concluded that trinitrin was as effective, both subjectively and objectively, in patients on propranolol as in those without beta blockade and promoted similar side effects.
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PMID:The combined clinical and hemodynamic effects of trinitrin and propranolol. 40 4

Vasodilator therapy has been shown to improve ventricular function in patients with left ventricular failure complicating acute myocardial infarction. Sublingual nitroglycerin also improves ventricular function in these patients but its effects are transient and variable. Infusion of intravenous nitroglycerin in 12 patients with acute infarction resulted in a decrease in left ventricular filling pressure from a mean of 22 plus or minus 2 mm Hg to 12 plus or minus 1 mm Hg (P less than 0.001) associated with a 7 mm Hg decrease in mean arterial pressure (P less than 0.05). Since stroke work index did not change significantly, this represents and improvement in ventricular performance and/or an alteration in ventricular compliance. All six patients in whom serial precordial mapping studies were performed showed a decrease in sigma ST (P less than 0.001). These findings suggest that intravenous nitroglycerin improved left ventricular function and decreased the extent of myocardial ischemia. Longer infusion may act to preserve borderline ischemic myocardium and thus limit infarct size.
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PMID:Intravenous nitroglycerin in acute myocardial infarction. 80 31

Fourteen patients with acute myocardial infarction were given 0.3 mg sublingual nitroglycerin within the first 12 hours of their acute myocardial infarction. Five minutes after sublingual nitroglycerin mean arterial pressure fell 9 mmHg (1.2 kPa) and remained significantly reduced for 30 minutes. Pulmonary capillary wedge pressure fell from a mean control value of 17 to 12 mmHg (2.3 to 1.6 kPa) and also remained reduced for 30 minutes. Heart rate was significantly raised and stroke work index reduced at five minutes. Patients with a stroke work index of greater than 55 g m per m-2 b.s.a. responed to nitroglycerin with a fall in both pulmonary capillary wedge pressue and strokework index while in those with a stroke work index of less than 55 g m per m-2 b.s.a. stroke work index did not fall concomitantly with the fall in pulmonary capillary wedge pressure. In one patient, nitroglycerin led to a precipitious fall in arterial pressure andrecurrence of chest pain.
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PMID:Role of sublingual nitroglycerin in patients with acute myocardial infarction. 80 10

Haemodynamic investigations were performed before and after oral ingestion of nitroglycerine and isosorbide dinitrate, both in depot form, in eleven and nine patients, respectively, with coronary heart disease. Nitroglycerine (5 mg) led to a significant decrease in arterial and pulmonary artery mid-pressure over one to two hours. Heart rate and mean pulmonary capillary pressure as well as cardiac output and stroke volume hardly changed. After ingestion of isosorbide dinitrate (20 mg) there was a continuous and significant fall in mean arterial, pulmonary artery, and pulmonary capillary pressure already demonstrable during the first hour. Cardiac output and left ventricular work decreased accordingly for up to four hours. At the same time the cardiac output remained constantly lowered over four hours despite the significant increase in frequency. Isosorbide dinitrate has thus a more complete and longer lasting protective haemodynamic effect than nitroglycerine.
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PMID:[Long-term action of nitrites in coronary heart disease (author's transl)]. 80 39


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