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[Hemodynamic effects of intravenous isosorbide dinitrate in chronic heart failure (author's transl)]
Insights
Isosorbide dinitrate (ISDN) showed excellent functional tolerance in patients with left ventricular failure, but its effectiveness was limited by insufficient doses and severe initial hemodynamic conditions.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Cardiac catheterization procedures
- Left ventricular failure management
Purpose:
- To evaluate the efficacy of intravenous isosorbide dinitrate (ISDN) in patients with left ventricular failure during cardiac catheterization.
- To determine optimal dosing strategies for ISDN in this patient population.
Summary:
- Ten patients with left ventricular failure received intravenous ISDN. Doses varied (500-800 gamma bolus, 2.5-10 mg/hr infusion).
- Excellent functional tolerance was observed, with stable heart rate and minimal systolic pressure decrease.
- Left ventricular filling pressures normalized in 4 patients, decreased in 3, and unchanged in 3. Cardiac output increased significantly in 4 patients.
- Partly effective due to insufficient doses and poor initial hemodynamic conditions.
Impact:
- Highlights the need for careful dose titration of ISDN in severe left ventricular failure.
- Suggests that ISDN can be safely administered in this setting, but efficacy is dose-dependent.
- Provides insights into hemodynamic responses to ISDN in critically ill cardiac patients.
Abstract:
During cardiac catheterization, isosorbite dinitrate (ISDN) was given intravenously to ten patients with confirmed left ventricular failure (10 NOMC, 1 ischemic cardiopathy, 1 valvular disease). When the left ventricular filling pressure was above 15 mmHg and the systemic systolic pressure exceeded 100 mmHg, a 500 gamma (first half of patients) or 800 gamma (second half of patients) bolus of ISDN was given intravenously, followed by an infusion of 2.5, 5 or 10 mg ISDN per hour. In all patients, the functional tolerance was excellent ; the heart rate remained unchanged and the systolic systemic pressure decreased only slightly (10 %). Left ventricular filling pressures returned to normal in four patients, decreased significantly in three, and remained unchanged in three. The cardiac output increased significantly in four patients. The poor initial hemodynamic conditions and the doses given, subsequently considered insufficient especially during the first part of the study, probably explain why ISDN was only partly effective.