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European Heart Journal 1991 12(12):1278-1282;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Intravenous nitroglycerin suppresses exercise-induced arrhythmias in patients with ischaemic heart disease: implications for long-term treatment

A. MARGONATO, F. BONETTI, A. MAILHAC, G. VICEDOMINI, D. CIANFLONE and S. L. CHIERCHIA

Division of Cardiology, Instituto Scientifico Ospedale San Raffaele Via Olgettina, 60, 20132 Milano, Italy

Correspondence: Alberto Margonato, MD, Cardiovascular Dpt. San Raffaele Hospital, Via Olgettina, 60, 20132 Milano, Italy

Abstract

We studied 20 patients with ischaemic heart disease, who consistently developed complex ventricular arrhythmias during exercise testing. Treadmill exercise was performed twice, both during the placebo infusion and then during intravenous administration of nitroglycerin, titrated to reduce systolic blood pressure by 10 mmHg. Exercise duration in those administered placebo was 7·8 ± 1·7 and 7·9 ± 1·5 min, respectively (ns): angina developed in five patients and ischaemic ST changes in 10. In those administered nitroglycerin, exercise duration increased to 8·4 ± 2 mm (P<0·05). Diagnostic ST segment depression was observed in only two patients and only one had angina. Ventricular arrhythmias, consistently present during both tests on those administered placebo, were dramatically reduced by nitroglycerin in all 20 patients. There were 455 (mean 35·8± 16·8) and 4l8 (mean 34·4±11·1) ventricular ectopic beats in the two exercise tests on those administered placebo and 11 in those receiving the nitroglycerin infusion (mean 0·6 ± 0·1 (P<0·001). There were 28 and 29 couplets in those receiving placebo (ns) and none in those receiving nitroglycerin (P<0·001). Ventricular tachycardia was present in six and eight patients who received placebo but in none in those administered nitroglycerin (P<0·001). Abolition of exercise-induced arrhythmias was maintained during chronic treatment with oral coronary vasodilators. Prevention of exercise-related arrhythmias by nitroglycerin appears a good indicator of their ischaemic origin and may provide valuable information for long-term prophylaxis with oral vasodilators, thus avoiding antiarrhythmic agents with their potential side effects.

Key Words: lschaemic heart disease • nitrates • exercise-induced arrhythmias


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