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(Circulation. 1972;46:839.)
© 1972 American Heart Association, Inc.

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Use of Sublingual Nitroglycerin in Congestive Failure following Acute Myocardial Infarction

HERMAN K. GOLD M.D.¹; ROBERT C. LEINBACH M.D.¹; CHARLES A. SANDERS M.D.¹

¹ From the Medical Service of the Massachusetts General Hospital and the Department of Medicine, Harvard Medical School, Boston, Massachusetts.

The effect of 0.3 mg sublingual nitroglycerin (NTG) was evaluated by hemodynamic measurements and precordial S-T-segment mapping in 17 patients following acute myocardial infarction.

In all cases NTG produced a prompt reduction in mean pulmonary capillary wedge pressure (PCW) from an average of 19 ± 2 to 14 ± 1 mm Hg associated with a small fall in mean arterial pressure from a mean of 85 ± 4 to 82 ± 4 mm Hg. No significant change in heart rate occurred.

In patients without left ventricular failure (PCW 3-12 mm Hg) cardiac output (CO) fell 9%. By contrast, in patients with moderate left ventricular failure (PCW 13-22 mm Hg) CO rose 18%. In three patients with refractory left ventricular failure (PCW 25-31 mm Hg) CO rose 25%. Two of these patients were treated with repetitive NTG doses in addition to previously ineffective diuretic therapy with resolution of resistant pulmonary edema. No significant changes in the magnitude of S-T-segment elevations were noted.

NTG may have a special role in the management of acutely ill patients with myocardial infarction in whom pulmonary edema does not respond to conventional therapy.

Key Words: Pulmonary edema • Vasodilator therapy

Submitted on April 17, 1972
Accepted on July 11, 1972

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