Therapeutic scope of intravenous nitroglycerin

Sublingual nitroglycerin has been the time-honored therapy for angina pectoris for nearly a century. Sustained-action oral forms and cutaneous ointment have been used for perhaps ten years for prophylactic treatment of angina and even more recently have been recommended for use in congestive failure. For the past six years investigators at Johns Hopkins Hospital have been administering intravenous nitroglycerin to patients with acute myocardial infarction with and without left ventricular failure. More recently, we have employed intravenous nitroglycerin to manage acute hypertension developing in patients before and after coronary artery bypass graft surgery. I would like to review with you the current indications for intravenous nitroglycerin and the beneficial effects that would be expected in each clinical situation. I will draw on our own clinical experience obtained in nearly 200 patients and, when necessary, on the recent medical literature.