Journal ArticleDOI
Pharmacokinetic-hemodynamic studies of nitroglycerin ointment in congestive heart failure
TLDR
This study demonstrates a good relation between the dose of nitroglycerin ointment and nitrogoglyin bioavailability and also provides therapeutic levels of nitreglycerin associated with substantial hemodynamic benefit in selected patients with cardiac failure.Abstract:
The aim of this study was to determine the bioavailability of nitroglycerin after application of nitroglycerin ointment in patients with heart failure and to examine whether a correlation exists between plasma nitroglycerin and its hemodynamic effects. The dose of nitroglycerin ointment selected was based on the prior hemodynamic response of individual patients to an intravenous infusion of nitroglycerin. Nine patients received 1 to 2 inches of nitroglycerin ointment on a single skin site (small dose group) and five patients received 4 inches (2 inches to two separate skin sites, large dose group). There was good correlation between the dose of nitroglycerin ointment and bioavailability (area under the plasma concentration time curve from 0 to 240 minutes) (r = 0.81, p mm Hg and in right atrial pressure from 14 ±7 to 11 ±6 mm Hg. There was a greater decrease in pulmonary capillary wedge pressure in the small dose group (31 percent) compared with the large dose group (13 percent) (p ng / ml at 60 minutes and remained at that level through 240 minutes. In the large dose group a plasma nitroglycerin level of 8.9 ± 4.0 ng / ml was achieved at 60 minutes and sustained through 240 minutes. Despite this plasma nitroglycerin level there was little decline in pulmonary capillary wedge pressure. This study demonstrates a good relation between the dose of nitroglycerin ointment and nitroglycerin bioavailability; nitroglycerin ointment also provides therapeutic levels of nitroglycerin associated with substantial hemodynamic benefit in selected patients with cardiac failure.read more
Citations
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Journal ArticleDOI
Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure.
Stuart D. Katz,Luigi M. Biasucci,Carlo Sabba,Joel A. Strom,Guillaume Jondeau,Marie Galvao,Steven B. Solomon,Srdjan D. Nikolic,Robert Forman,Thierry H. LeJemtel +9 more
TL;DR: In this paper, the local vascular response to intraarterial infusions of graded concentrations of acetylcholine and nitroglycerin was studied in the superficial femoral artery of 19 patients with congestive heart failure (New York Heart Association classes I to IV) and 6 age-matched normal control subjects.
Journal ArticleDOI
Trainsdermal nitroglycerin in angina pectoris
TL;DR: It is suggested that TGTN patches are of inadequate size to produce 24-hour antianginal protection during sustained therapy, as tolerance develops to theAntianginal efficacy of this form of GTN administration.
Journal ArticleDOI
Hemodynamic and Hormonal Response to Transdermal Nitroglycerin in Normal Subjects and in Patients With Congestive Heart Failure
TL;DR: Transdermal absorption of this new form of nitroglycerin appears to provide a nitrate vascular effect that is sustained for 24 hours, but an endogenous vasoconstrictor effect may influence the hemodynamic response over the first 24 hours.
Journal ArticleDOI
Transdermal isosorbide dinitrate in angina pectoris: effect of acute and sustained therapy.
TL;DR: Transdermal ISDN in a dose of 100 mg is effective for 8 hours during acute therapy, but during sustained therapy tolerance developed and no antianginal effects of ISDN persisted.
References
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Nomenclature and criteria for diagnosis of diseases of the heart and great vessels
TL;DR: This edition restores the functional capacity component of the classification (dropped from the past two editions) and introduces an objective assessment category.
Journal ArticleDOI
Thermodilution cardiac output determination with a single flow-directed catheter.
James S. Forrester,William Ganz,George A. Diamond,Thomas J. McHugh,David W. Chonette,H.J.C. Swan +5 more
TL;DR: A single right heart catheter which allows simultaneous determinations of cardiac output, pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure in critically ill patients is described.
Journal ArticleDOI
Augmentation of the plasma nor-epinephrine response to exercise in patients with congestive heart failure.
TL;DR: In patients in whom the cardiac reserve is diminished, the normal increase of cardiac output during exercise is attenuated, or even abolished, and Diminished activity of this important reserve mechanism could be a factor in the abnormal cardiac activity.
Journal ArticleDOI
Role of the renin-angiotensin system in the systemic vasoconstriction of chronic congestive heart failure.
TL;DR: The renin-angiotensin system appears to have an important role in the elevated SVR in some patients with heart failure, and chronic inhibition of converting enzyme should be explored as a possible therapeutic approach.
Journal ArticleDOI
Use of Sublingual Nitroglycerin in Congestive Failure following Acute Myocardial Infarction
TL;DR: 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 and is treated with repetitive NTG doses in addition to previously ineffective diuretic therapy.