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Effects of nitroglycerin on the major determinants of myocardial oxygen consumption

An angiographic and hemodynamic assessment
  • Henry Greenberg
    Correspondence
    Address for reprints: Henry Greenberg, MD, Coronary Care Unit, The Roosevelt Hospital, 428 West 59 St., New York, N. Y. 10019.
    Footnotes
    Affiliations
    Division of Cardiology, Medical Service, The Roosevelt Hospital, New York, N. Y., USA

    The Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N. Y., USA
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  • Edward M Dwyer Jr.
    Affiliations
    Division of Cardiology, Medical Service, The Roosevelt Hospital, New York, N. Y., USA

    The Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N. Y., USA
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  • A.Gregory Jameson
    Affiliations
    Division of Cardiology, Medical Service, The Roosevelt Hospital, New York, N. Y., USA

    The Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N. Y., USA
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  • Bruce H Pinkernell
    Affiliations
    Division of Cardiology, Medical Service, The Roosevelt Hospital, New York, N. Y., USA

    The Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N. Y., USA
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  • Author Footnotes
    ∗ This work was done in part during Dr. Greenberg's tenure as a Fellow sponsored by the New York Heart Association.
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      Abstract

      A direct and quantitative study of the effects of sublingually administered nitroglycerin on the major determinants of myocardial oxygen consumption was carried out in 10 patients, 7 with coronary artery disease. Left ventricular wall tension, estimates of the contractile state and heart rate were studied directly using simultaneous pressure measurements and angiographically obtained volume determinations.
      The peak systolic left ventricular wall tension decreased 15 percent after administration of nitroglycerin, suggesting a diminished myocardial oxygen requirement. Increased myocardial oxygen requirements were suggested by the occurrence of both positive chronotropic and inotropic effects. Heart rate increased 15 percent. The mean circumferential fiber shortening velocity increased 26 percent and the ejection fraction 30 percent; these findings, in association with a 23 percent reduction in left ventricular end-diastolic volume, were considered consistent with an increase in the contractile state. The mechanism of action of nitroglycerin seems to relate best to the decrease in systolic wall tension. The end-diastolic tension decreased 57 percent, suggesting the possibility that diastolic coronary blood flow may be augmented by diminished extravascular resistance to flow.
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