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European Heart Journal 1990 11(7):649-655;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Comparative haemodynamic effects of transdermal vs intravenous nitroglycerin in acute myocardial infarctionwith elevated pulmonary artery wedge pressure

G. Melandri, F. Semprini, A. Branzi and B. Magnani

Institute of Cardiology, University of Bologna Italy

Received 3 May 1989; revised 9 October 1989; .

Address correspondence to: Dr Giovanni Melandri, Istituto di CardioJogia, PoUchnko S.Orsola via Massarenti 9 40138 Bologna, Italy.

Abstract

The comparative haemodynamic effects of transdermal and intravenous nitroglycerin were evaluated in 16 patients with haemodynamic and radiographic left heart failure following a recent myocardial infarction. After the control period patients were randomized to transdermal (10mg(24h)–1) or intravenous (mean dose: 40±9 µg min–1) nitroglycerin. Haemodynamic parameters were recorded after 05, 1, 2, 6, 12, 18 and 24 h during administration of the drug and 2 h after drug discontinuation. After the washout period the alternate system of nitroglycerin administration was adopted, according to a cross-over design. No differences were found in baseline measurements.

Transdermal nitroglycerin reduced the pulmonary artery wedge pressure after 0.5h (from 21±5 to 16±5 mmHg; P<0.05). The peak effect occurred at 2 h (12±5 mmHg). The improvement was sustained over 24 h. Transdermal nitroglycerin also significantly reduced mean pulmonary arterial and right atrial pressures (from 28 ±3 to 20 ±5 mmHg and from 6±3 to 2±2 mmHg at peak effect, respectively). Cardiac index increased from 2.5 ± 06 to 2.8 ± 0.81 min–1m–2 (P < 0.05). There was no change in heart rate.

Similar haemodynamic changes were observed after the intravenous infusion of nitroglycerin. Thus transdermal nitroglycerin is a safe and effective treatment of acute myocardial infarction with signs of left ventricular failure when an intravenous nitroglycerin infusion cannot be properly implemented.

Key Words: Acute myocardial infarction • transdermal nitroglycerin • acute left heart failure


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