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Systemic and coronary hemodynamic effects of combined intravenous diltiazem and nitroglycerin administration
Insights
Intravenous diltiazem and nitroglycerin (NTG) combination therapy favorably impacts hemodynamics in severe coronary disease patients. Both drugs, individually and combined, maintained coronary blood flow without adverse effects on cardiac function.
Area of Science:
- Cardiology
- Pharmacology
- Cardiovascular Physiology
Background:
- Severe coronary artery disease poses significant challenges for hemodynamic management.
- Intravenous diltiazem and nitroglycerin (NTG) are commonly used cardiovascular medications.
- Understanding their combined hemodynamic effects is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the left ventricular (LV) and coronary hemodynamic effects of intravenous NTG during an infusion of diltiazem.
- To assess the safety and efficacy of this combination therapy in patients with severe coronary disease.
Main Methods:
- Fifteen patients with severe coronary disease received intravenous diltiazem followed by intravenous NTG.
- Hemodynamic parameters including systemic blood pressure, heart rate, LV pressure, and coronary blood flow (coronary sinus and great cardiac vein) were measured.
- The sequence of drug administration was reversed in a subset of patients to assess order-dependent effects.
Main Results:
- Diltiazem alone decreased mean systemic blood pressure and peripheral resistance, with preserved coronary flows.
- Addition of NTG further reduced systemic pressure and LV end-diastolic pressure, with a slight increase in heart rate.
- Coronary sinus and great cardiac vein flows remained stable throughout the combination therapy.
- Reversing the drug administration sequence yielded similar hemodynamic outcomes.
Conclusions:
- Intravenous diltiazem and NTG combination therapy demonstrates potentially favorable hemodynamic effects in patients with ischemic heart disease.
- The combination appears safe, maintaining adequate coronary perfusion without compromising LV function.
- These findings support the consideration of this combined regimen in managing severe coronary disease.
Abstract:
This study evaluated left ventricular (LV) and coronary hemodynamic effects of intravenous nitroglycerin (NTG) in the presence of an intravenous infusion of diltiazem in 15 patients with severe coronary disease. Diltiazem (250 microgram/kg bolus followed by 1.4 micrograms/kg/min infusion) alone decreased mean systemic blood pressure (mean 6%) without changing heart rate or LV end-diastolic pressure. The rate of rise in LV pressure declined slightly (4%), and peripheral resistance decreased (19%). Coronary sinus (CS) and great cardiac vein (GCV) flows were preserved. Addition of NTG (average, 68 micrograms/min) decreased systemic pressure further (7%) as LV end-diastolic pressure declined (5 mm Hg). These pressure changes were accompanied by a 10% increase in heart rate (compared with the heart rate found with diltiazem alone). Peripheral resistance was similar to values after diltiazem alone. The CS and GCV flows did not decrease. The sequence of intravenous drug administration was reversed in three other patients with combination therapy, producing similar effects, regardless of which drug was administered first. Hemodynamic effects of intravenous diltiazem alone and its combination with intravenous NTG seemed potentially favorable for patients with ischemic heart disease.