Advertisement

Effect of intravenous isosorbide dinitrate versus nitroglycerin on elevated pulmonary arterial wedge pressure during acute myocardial infarction

  • Guillermo B. Cintron
    Correspondence
    Address for reprints: Guillermo B. Cintron, MD, Cardiology Section (111A), James A. Haley Veterans Administration Hospital, 13000 Bruce B. Downs Boulevard, Tampa, Florida 33612.
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • Stephen P. Glasser
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • Barbara Arce Weston
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • Esteban Linares
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • C.Richard Conti
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • Participating Investigators
    Footnotes
    Affiliations
    From the Cardiology Section, Department of Medicine, the University of South Florida College of Medicine, Tampa, USA

    From the Veterans Administration Hospital, Tampa, Florida, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Participating investigators are listed in the Appendix. These studies were performed with support from a grant by Wyeth Laboratories, Philadelphia, Pennsylvania, and with support by the Veterans Administration and the participating institutions.
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      To compare the acute and sustained effect of intravenous isosorbide dinitrate to intravenous nitroglycerin in patients with acute myocardial infarction and elevated pulmonary artery wedge pressure, 111 patients were randomized and studied within 96 hours of admission to the coronary care unit. All patients had a pulmonary artery wedge pressure ≥18 mm Hg and received either isosorbide dinitrate (74 patients) or nitroglycerin (37 patients) for 24 to 48 hours. Blood pressure, heart rate, pulmonary artery wedge pressure, cardiac output, medication dose in micrograms per minute and retitration episodes were compared at baseline and at 6, 12, 18 and 24 hours. Both drugs significantly (p < 0.05) lowered pulmonary artery wedge pressure and blood pressure and increased cardiac output. Isosorbide dinitrate required fewer retitration episodes and less increases in dosage than nitroglycerin at 24 hours. In the patient with acute myocardial infarction complicated by high pulmonary artery wedge pressure who requires intravenous nitrates for 24 hours, isosorbide dinitrate may offer the benefit of a more stable hemodynamic effect.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hill NS
        • Antman EM
        • Green LH
        • Alpert JS
        Intravenous nitroglycerin.
        Chest. 1981; 79: 69-77
        • Kaplan K
        • Davison R
        • Parker M
        • Przybylek I
        • Teagarden JR
        • Lesch M
        Intravenous nitroglycerin for the treatment of angina at rest unresponsive to standard medical therapy.
        Am J Cardiol. 1983; 51: 694-698
        • Roberts R
        Intravenous nitroglycerin in acute myocardial infarction.
        Am J Med. 1983; 74: 45-52
        • Flaherty JT
        • Becker LC
        • Bulkley BH
        • Weiss JL
        • Gerstenblith G
        • Kallman CH
        • Silverman KJ
        • Wei JY
        • Pitt B
        • Weisfeldt ML
        A randomized prospective trial of intravenous nitroglycerin in patients with acute myocardial infarction.
        Circulation. 1983; 68: 576-588
        • Jordan RA
        • Seth L
        • Casebolt C
        • Hayes MJ
        • Wilen MM
        • Franciosa J
        Rapidly developing tolerance to transdermal nitroglycerin in congestive heart failure.
        Ann Intern Med. 1986; 104: 295-298
        • Thadani U
        • Hamilton SF
        • Olson E
        • Anderson J
        • Voyles W
        • Prasad R
        • Teague SM
        Transdermal nitroglycerin patches in angina pectoris.
        Ann Intern Med. 1986; 105: 485-492
        • Zimrin D
        • Reichek N
        • Bogin K
        • Cameron S
        • Douglas P
        • Fung HL
        Antianginal effects of IV nitroglycerin (abstr).
        Circulation. 1985; 72: III-460
        • Packer M
        • Medina N
        • Yushak M
        Rapid attenuation of hemodynamic efficacy of continuous transcutaneous nitroglycerin in severe heart failure: lack of cross tolerance of isosorbide dinitrate (abstr).
        Circulation. 1984; 70: II-113
        • Rabinowitz B
        • Tamari I
        • Elazar E
        • Neufeld HN
        Intravenous isosorbide dinitrate in patients with refractory pump failure and acute myocardial infarction.
        Circulation. 1982; 65: 771-778
        • Leier CV
        • Bambach D
        • Thompson MJ
        • Cattaneo SM
        • Goldberg RJ
        • Unverferth DV
        Central and regional hemodynamic effects of intravenous isosorbide dinitrate, nitroglycerin and nitroprusside in patients with congestive heart failure.
        Am J Cardiol. 1981; 48: 1115-1123
        • Nelson GIC
        • Silke B
        • Ahuja RC
        • Hussain M
        Hemodynamic advantages of isosorbide dinitrate over furosemide in acute heart failure following myocardial infarction.
        Lancet. 1983; 1: 730-733
        • Parker JO
        • Fung HL
        Transdermal nitroglycerin in angina pectoris.
        Am J Cardiol. 1984; 54: 471-476
        • Reicheck LN
        • Priest CM
        • Zimrin D
        • Chandler T
        • Sutton MSJ
        Limited antianginal effects of nitroglycerin patches.
        Am J Cardiol. 1984; 54: 1-7
        • Leier CV
        Nitrate tolerance.
        Am Heart J. 1985; 110: 204-232
        • Parker JO
        • Fung HL
        • Ruggirello D
        • Stone JA
        Tolerance to isosorbide dinitrate: rate of development and reversal.
        Circulation. 1983; 68: 1074-1080
        • Packer M
        • Lee HW
        • Kessler P
        • Medina N
        • Yushak M
        Induction of nitrate tolerance in human heart failure by continuous intravenous infusion of nitroglycerin and reversal of tolerance by n-acetylcysteine, a sulfhydryl donor (abstr).
        JACC. 1986; 7: 27A
        • Lee G
        • Mason DT
        • De Maria AN
        Effects of long-term oral administration of isosorbide dinitrate on the antianginal response to nitroglycerin.
        Am J Cardiol. 1978; 41: 82-87
        • Franciosa JA
        • Cohn JN
        Sustained hemodynamic effects without tolerance during long-term isosorbide dinitrate treatment of chronic left heart failure.
        Am J Cardiol. 1980; 45: 648-654
        • Parker JO
        • Vankoughnett KA
        • Fung HL
        Transdermal isosorbide dinitrate in angina pectoris: effect of acute and sustained therapy.
        Am J Cardiol. 1984; 54: 8-13