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• W2041352438 abstract "SUMMARYNitroglycerin and nitrates have long been contraindi-cated in the treatment of acute myocardial infarction because of the possibility of an undesirable decrease in arterial blood pressure and the induction of cardiogenic shock. Nowadays nitroglycerin seems to be indicated at least in subgroups of patients with acute myocardial infarction. Intravenous nitroglycerin reduce left ventricular filling pressure up to 40% within several minutes. The effect is most pronounced if filling pressure is elevated. There is no decrease in arterial pressure with low dosage nitroglycerin and a 10 % decrease with higher dosages. Cardiac output and stroke volume were found to increase following nitroglycerin application in patients with left ventricular failure. This may be due to the improved regional ventricular function in areas with decreased coronary flow. A slight, but significant decrease in cardiac output was found in patients not in failure. Nitroglycerin seems to be the drug of choice in acute pulmonary edema, because of its internal bloodletting effect. Following sublingual nitroglycerin, left ventricular filling pressure decreased within 3–5 minutes in conjunction with clinical improvement of the patient.High blood pressure in such patients is largely reduced. — Nitroglycerin, therefore, seems to be applicable even in patients with acute and marked arterial hypertension.Clinical improvement was evident in patients with dyspnea or pain following myocardial infarction. The need for morphine was reduced. Myocardial ischemia as assessed by electrocardiographic ST-segment elevation improved following application of nitroglycerin. This effect is more pronounced in patients with left ventricular failure.In a randomized prospective study, 31 patients received intravenous nitroglycerin at least for 2 days and were compared to 29 patients with no specific therapy. CK and CKMB infarct size was 30 % less than in the control group. Even with nitroglycerin administration 8 hours after the onset of symptoms, CK and CKMB activities were significantly reduced.Preliminary results showed early mortality to be reduced in patients receiving nitroglycerin; The rate of reinfarction also was lower. The incidence of angina pectoris 1 1/2 years after the infarct, however, was higher in patients receiving nitroglycerin therapy initially. Following infarct size reduction more ischemic myocardium remains, possible indication for further therapy such as bypass surgery. The improvement in myocardial ischemia seems to be the reason for the reduction in ventricular ectopic beats during treatment. The need for lidocaine was markedly reduced. Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure." @default.
• W2041352438 created "2016-06-24" @default.
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• W2041352438 date "2009-04-24" @default.
• W2041352438 modified "2023-09-23" @default.
• W2041352438 title "NITROGLYCERIN IN THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION" @default.
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• W2041352438 doi "https://doi.org/10.1111/j.0954-6820.1981.tb03652.x" @default.
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