Nitroglycerin remains a first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin achieves its benefit by giving rise to nitric oxide, which causes vasodilation
Vasodilation
Vasodilation (or vasodilatation) refers to the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. In essence, the process is the opposite of vasoconstriction, whic…
Nitroglycerin
Nitroglycerin extended-release capsules are used to prevent chest pain in people with a certain heart condition.
How does intravenous nitroglycerin work in acute myocardial infarction?
Intravenous nitroglycerin lowers left ventricular filling pressure and systemic vascular resistance in patients with acute myocardial infarction. At lower infusion rates (less than 30 micrograms/min) nitroglycerin acts principally as a venodilator, while at higher infusion rates a balanced venous and arterial dilating effect is seen.
Is glyceryl trinitrate (GTN) a first-line treatment for acute myocardial infarction?
Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI. Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes v … Nitroglycerin use in myocardial infarction patients Circ J. 2012;76(1):15-21.doi: 10.1253/circj.cj-11-1133. Epub 2011 Nov 1. Authors
Is nitroglycerin a first-line treatment for angina pectoris?
Nitroglycerin remains a first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin achieves its benefit by giving rise to nitric oxide, which causes vasodilation and increases blood flow to the myocardium.
What is nitroglycerin used for in heart disease?
Nitroglycerin. In the majority of patients with stable ischemic heart disease (SIHD), long-acting nitrates are used as part of OMT to reduce the risk of cardiovascular morbidity (notably angina and myocardial ischemia) and thus, to enhance the quality of life by reducing symptoms 8 and improving exercise capacity.
What are the benefits of nitroglycerin in treating a patient with heart disease?
Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen.
Why is nitroglycerin used for stemi?
In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7% decrease in subjective pain experienced by the patient and reduced need for additional opioids.
Why do you not give Nitro to inferior MI?
Nitroglycerin is also contraindicated in the setting of an inferior MI with right ventricular involvement because, in this specific situation, the heart is dependent on preload.
How does nitroglycerin promote vasodilation?
The body breaks nitroglycerin down into nitric oxide. Nitric oxide causes the smooth muscle within the blood vessels to relax. This allows the arteries and veins to open up, allowing more blood to flow through. Healthcare professionals call this action vasodilation.
What is the treatment for acute myocardial infarction?
Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI. Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes vasodilation and increases blood flow to ...
Does Nitroglycerin increase blood flow?
Nitroglycerin achieves its benefit by giving rise to nitric oxide (NO), which causes vasodilation and increases blood flow to the myocardium. However, continuous delivery of GTN results in tolerance, limiting the use of this drug.
Is nitroglycerin used for angina pectoris?
Acute myocardial infarction (MI) and its sequelae are leading causes of morbidity and mortality worldwide. Nitroglycerin (glyceryl trinitrate [GTN]) remains a first-line treatment for angina pectoris and acute MI.
Why is nitrate used in myocardial infarction?
Nitroglycerin and nitrates have long been contraindi-cated in the treatment of acute myocardial infarction because of the possibility of an undesirable decrease in arterial blood pressure and the induction of cardiogenic shock.
Is nitroglycerin good for hypertension?
— Nitroglycerin, therefore, seems to be applicable even in patients with acute and marked arterial hypertension.
Does nitroglycerin help with myocardial infarction?
Nowadays nitroglycerin seems to be indicated at least in subgroups of patients with acute myocardial infarction. Intravenous nitroglycerin reduce left ventricular filling pressure up to 40% within several minutes. The effect is most pronounced if filling pressure is elevated.
Does atropine help with bradycardia?
Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure.
Does nitroglycerin help with pulmonary edema?
Nitroglycerin seems to be the drug of choice in acute pulmonary edema, because of its internal bloodletting effect. Following sublingual nitroglycerin, left ventricular filling pressure decreased within 3–5 minutes in conjunction with clinical improvement of the patient.
Does nitroglycerin reduce mortality?
Preliminary results showed early mortality to be reduced in patients receiving nitroglycerin; The rate of reinfarction also was lower. The incidence of angina pectoris 1 1/2 years after the infarct, however, was higher in patients receiving nitroglycerin therapy initially. Following infarct size reduction more ischemic myocardium remains, possible indication for further therapy such as bypass surgery. The improvement in myocardial ischemia seems to be the reason for the reduction in ventricular ectopic beats during treatment. The need for lidocaine was markedly reduced. Even bradycardia seems to be improved, since the use for atropine was only half that for the control patients. These results provide evidence that nitroglycerin and nitrates appear to be indicated in patients with acute myocardial infarction, especially in those with left ventricular failure.
What is the use of nitroglycerin?
Use of nitroglycerin in the treatment of acute heart failure and cardiogenic shock in patients with myocardial infarction
Is nitroglycerin effective in heart failure?
The effectiveness of nitroglycerin in the treatment of acute heart failure was investigated in 100 patients with myocardial infarction. It was found that nitroglycerin has marked advantages in comparison with cardiac glycosides both as regards its effectiveness and as regards the character of its action on the haemodynamics and the state of the periinfarction zone. In most patients (78%), a favourable effect was attained with intravenous nitroglycerin administration and with additional intake in the form of tablets. Clinical improvement was preceded by normalization of pulmonary artery pressure. Uninterrupted nitroglycerin administration was terminated after normalization and stabilization of haemodynamics. The results showed that with monitoring haemodynamics nitroglycerin can be administered also in haemodynamic disorders, which occur in the early period of cardiogenic shock.
How many doses of nitroglycerin are in a canister?
Nitroglycerin spray is available in a 0.4 mg metered-dose canister that dispenses 200 dos es. The tablets should be placed under the tongue and not swallowed. If the spray is used, it should be applied to the tongue and not swallowed or inhaled.
How long does it take to take sublingual nitroglycerin?
When angina starts, the patient should rest in the sitting posture (standing promotes syncope and lying down enhances venous return and heart work) and take sublingual nitroglycerin (0.3 to 0.6 mg) every 5 minutes until the pain subsides or a maximum of 1.2 mg has been taken within 15 minutes. Nitroglycerin spray acts more rapidly. Nitroglycerin can be used prophylactically when angina is anticipated, such as with activity after a meal, emotional stress, sexual activity, and in colder weather.
What is nitrate metabolized to?
Organic nitrates are metabolized to NO (or its S-nitrosothiol congener), which is a potent activator of platelet guanylate cyclase. Activation of guanylate cyclase increases levels of platelet cGMP and leads to decreased fibrinogen binding to the glycoprotein IIb/IIIa receptor. As fibrinogen binding is critically essential for platelet aggregation, its inhibition leads to impairment of platelet function.27Further, Diodati et al evaluated the effect of a nitroglycerin infusion on platelet aggregation response to adenosine diphosphate and to thrombin in patients with unstable angina and acute MI.28Platelet response before, during, and after a 45-minute infusion of nitroglycerin showed >50% inhibition of platelet aggregation, which returned to normal 15 minutes after nitroglycerin discontinuation.28As platelet aggregation is a causal factor in acute coronary syndromes, inhibition of platelets by nitrates may suggest an additional potential mechanism to improve perfusion to ischemic myocardium.27
What is the acronym for the American College of Cardiology Foundation?
The 2011 American College of Cardiology Foundation (ACCF)/AHA focused on an update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction.3
Does nitroglycerin increase vasodilation?
Nitrates produce vasodilation, with predominant venous effects on large capacitance vessels. They also increase coronary collateral circulation, increase aortic compliance and conductance, and blood flow to ischemic areas of the myocardium.18–20Fam and McGregor observed that the heterogeneity of coronary flow was dependent on different sites of action of various coronary artery vasodilators.21,22Their work demonstrated that nitroglycerin, when administered intravenously, selectively relaxes the epicardial conductance vessels, thus facilitating flow through collateral arteries to zones of myocardial ischemia.21,22This led to the notion that nitroglycerin may exert part of its anti-anginal effect by preferentially directing blood flow to the ischemic myocardium. Follow-up studies have evaluated this hypothesis by using washout rates of intra-myocardial Xenon-133 (133Xe) in anesthetized open-chest hearts,23computer-assisted measurements of luminal stenosis,24,25and positron emission tomography with (13N) ammonia as a flow tracer.18Sublingual nitroglycerin can enhance perfusion in areas of the human myocardium supplied by coronary arteries with significant luminal stenosis, particularly the collateral vessels. Using the 133Xe washout technique in 31 patients in a stress-free resting state, Cohn et al demonstrated an improvement in regional myocardial blood flow (MBF) after sublingual nitroglycerin, most likely mediated through physiologically normally functioning collateral vasculature.26
Does nitroglycerin help with anginal symptoms?
Nitroglycerin alleviates anginal symptoms by decreasing myocardial oxygen consumption as a function of: 1) reducing preload, systolic wall stress, and afterload; 2) restoring flow imbalances; dilating coronary arteries (pre-stenotic, stenotic, and post-stenotic segments); 3) increasing subendocardial myocardial perfusion by lowering left ventricular diastolic pressure; 4) preventing coronary artery vasospasm; and 5) acting as a physiologic substitute for EDRF in endothelial dysfunction.14,17Due to the potent venodilatory effects on capacitance vessels, nitrates reduce left ventricular filling pressures and preload, which may be a very useful therapeutic adjunct clinically, in patients with heart failure.17
Is nitroglycerin a short acting medication?
Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated. Nitrates predominantly induce vasodilation in large capacitance blood vessels, increase epicardial coronary arterial diameter and coronary collateral blood flow, and impair platelet aggregation. The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life. Short-acting nitroglycerin, administered either as a sublingual tablet or spray, can complement anti-anginal therapy as part of optimal medical therapy in patients with refractory and recurrent angina either with or without myocardial revascularization, and is most commonly used to provide rapid therapeutic relief of acute recurrent angina attacks. When administered prophylactically, both formulations increase angina-free walking time on treadmill testing, abolish or delay ST segment depression, and increase exercise tolerance. The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable. Furthermore, the sublingual spray formulation may be advantageous to tablet preparations in patients with dry mouth. This review discusses the efficacy and utility of short-acting nitroglycerin (sublingual spray and tablet) therapy for both preventing and aborting an acute angina attack, thereby leading to an improved quality of life.
