This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by PARKER, J. O. Articles by ARMSTRONG, P. W. Search for Related Content PubMed PubMed Citation Articles by PARKER, J. O. Articles by ARMSTRONG, P. W.

(Circulation. 1970;41:593.)
© 1970 American Heart Association, Inc.

---

The Influence of Changes in Blood Volume on Angina Pectoris

A Study of the Effect of Phlebotomy

JOHN O. PARKER M.D.¹; ROBERT B. CASE M.D.¹; FAREEDUDDIN KHAJA M.D.¹; J. RODNEY LEDWICH M.D.¹; PAUL W. ARMSTRONG M.D.¹

¹ From the Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Angina pectoris was precipitated in 15 patients with coronary artery disease by the technic of right atrial pacing. This was accompanied by hemodynamic evidence of impaired left ventricular function. In eight patients, while pacing was continued, a phlebotomy averaging 276 ml was carried out and in all but one patient angina was relieved and ventricular function returned to normal. Phlebotomy was accompanied by a decline in cardiac index (9.6%) and left ventricular filling pressure, but no change in brachial artery mean pressure, tension-time index, or dp/dt. With reinfusion of blood, angina returned in all but one patient and there was a rise in left ventricular end-diastolic pressure but no change in cardiac index, brachial artery pressure, tension-time index, or dp/dt. In seven patients alterations of blood volume were carried out between three 9-minute periods of atrial pacing and similar observations were obtained. The observations indicate that phlebotomy exerted its beneficial effect through a reduction in left ventricular volume, and it is suggested that this may be the primary mode of action of nitroglycerin.

Key Words: Nitroglycerin • Left ventricular end-diastolic pressure • Atrial pacing • Oxygen consumption

Submitted on October 13, 1969
Accepted on December 2, 1969

This article has been cited by other articles:

				J. D. Parker, A. B. Parker, B. Farrell, and J. O. Parker Effects of Diuretic Therapy on the Development of Tolerance to Nitroglycerin and Exercise Capacity in Patients With Chronic Stable Angina Circulation, February 15, 1996; 93(4): 691 - 696. [Abstract] [Full Text]